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[IP] RE: reply to insurance questions


You are correct with your advice -- If insurance is paid for by an employer,
by all means take it!  Due to the high costs of health insurance in today's
world, it seems there are fewer and fewer employers doing this.

When were you refused coverage under your husband's policy?  Since HIPAA
(1996, I think) you cannot be refused coverage unless you don't meet the
guidelines (have you been without a 63-day or more break in coverage for the
last 18 months or more?  If so, you meet the guidelines for HIPAA to help
you avoid pre-ex).  You must be able to prove that you have had prior
coverage by providing a certificate of creditable coverage (if your
insurance carrier has changed recently, you've probably been sent one of
these).  I'm guessing that your bad experience was pre-1996.  If not, I'd be
calling the employer to question.  Sometimes you have to use the correct
words (or letters) to remind employers, carriers, etc. of your "rights" and
HIPAA, like COBRA, is one of the terms that is being monitored by the HCFA
(health care financing administration).

In my opinion, HIPAA s a great Act.  It allows those of us with a real need
for health insurance the opportunity to change jobs, without having to worry
about meeting the pre-existing condition requirements.  As many have
discovered, however, different plans & carriers treat diabetes supplies,
prescriptions, etc. very differently.  So it's important to ask lots of
questions upfront before deciding on the "right" insurance plan/s.

I certainly don't want to sound like an expert on any of the above, but from
experience I've learned that many people (employers too) are not aware of
their rights.


Date: Mon, 27 May 2002 22:11:30 -0400
From: "Annie Wall" <email @ redacted>
Subject: Re: [IP] reply to insurance question

Beckie,  I only meant to suggest that, if Donna is automatically covered on
her husband's policy (i.e., 100% covered by his employer and no cost to
him), that it would be a good idea to keep the coverage through her
husband's employer, in addition to her own employer's coverage, especially
if it does provide for coordination of benefits.  As you suggest, she (and
he) should find out the particulars from the insurers.

My concern is always the possiblity of not being covered by health
insurance.  I was once refused for coverage on my husband's policy through
his employer after I left a job where I had health insurance.  I did end up
keeping my former employer's insurance through COBRA but that only lasted 18
months and it was far more expensive than being included on my husband's
policy.  Are you saying that, with HIPAA, my husband's employer cannot
refuse to cover me under circumstances like this?

Thanks for any clarification you can provide.

> Annie,
> Sorry but I have to disagree with "dual" coverage (keeping 2 insurances).
Under many scenarios (not all), it is a waste of your premium dollars.
> Donna, you should check your husband's and your full-time employer's
Coordination Of Benefits provisions (COB) for health insurance BEFORE making
a decision.  I work for a health & disability insurance broker/consultant.
Now a days, it is not uncommon for 1 or both employers to say: if you have
other coverage, our plan will PAY $0 unless denied by the other carrier.
I've seen this more and more in the last couple years.  (I live in Maryland,
but I'm sure this is a "national trend" to help employers save $$$).
> You shouldn't have problems switching coverage from his plan to yours (&
vice versa) when you have an IRS qualified change in status (things such as
losing insurance, marriage, divorce, birth, etc.).  Pre-existing conditions
are a possibility under both plans, but only if you have been without
coverage (lapses of 63-days or more qualify).  If you have no break in
coverage, they cannot use pre-ex as an excuse.  HIPAA (Health Insurance
Portability & Accountability Act) is the saving grace for many of us with
pre-existing conditions.  It allows us to look for other jobs, etc. without
having to worry about losing our health insurance.
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