Question: I was laid off - my medical coverage ended on 3/31/2012. I did not elect cobra. I purchased a high deductible, no prescription coverage, bare bones health insurance policy that begain on 6/1/2012. On 6/14 I was diagnosed with multiple Sclerosis. I am a Pennsylvania Resident. I have a meeting with an Attorney to start filing for disability, but this could take a year or more and possible denial. What is my best option to obtain better coverage at this point, so I’m not buried medical expenses?

Answer: You cannot improve your health insurance coverage at this point. On the plus side, you do have coverage and help is coming. Assuming the Affordable Care Act stays in force, you will be able to upgrade your coverage on January 1, 2014. With MS, the big out-of-pocket expense for you will be prescription drugs. Please read this article 7 Ways to Cheaper Drugs.

Question: My nineteen year old son just graduated from high school in May and will be attending college full time in August. He has a part time job at Burger King working about thirty-two hours a week. Burger King offers insurance to it’s part-time workers but it costs more than he makes. My employer is kicking him off my insurance because he “has health insurance available through his employer.” He either has to quit his part-time job or go without health insurance until august. Is this legal? They state that this is Obama Care.

Answer: Your employer has no legal grounds for denying your dependent son coverage under your group health insurance plan - certainly not any part of “Obamacare”. But keep in mind that your employer can insist on a “company policy” that has no legal basis. That’s his prerogative. You may be legally right and loose your job.

Question: I have bariatric surgery scheduled for July 3rd under my Group Plan. Today I received notificaiton from my company this plan is being withdrawn and preplaced with 2 other options as of July 1st. I’ve had 6 months of workup prepration for this surgery and now I’m loosing the insurance. I’ve called my surgeon to see if we can move up the date. I have a few questions: even if I selected a new goup plan that my company is forcing me to pick from and different than what I have now, assuming this procedure will be coverd under a new plan, will I be forced to go through all the work up again for the new plan? Can I be denied for pre-existing condition - whether I have the surgury sooner and not be forced to the new plan or wait and have surgery under the new plan? What if I have complicaitons after the surgery on the new plan. Mindful, the new plan is not my choice, but my employer will drop what I have now and offer other plans. Please advise. (I live in CT, have a primary Dr. in CT, but my insurance company is out of Mass.)

Answer: The crux of your question is which insurance company is responsible for a claim when there is a change of insurers. In your case this change is taking place on July 1st, so the current insurance company is responsible for all medical services you receive prior to July 1st. These responsibilities are based on the dates-of-service not the date the claim is submitted or received by the insurer. The “new” insurance company would be responsible for your surgery assuming it’s done as scheduled on July 3rd. If you have the surgery done before July 1 you will need routine follow-up and if there are complications that require treatment, those claims will be the responsibility of the “new” company. No - you cannot be denied coverage for preexisting conditions under Massachusetts laws.

Your primary problem right now is that you don’t know if the new insurance plan will cover the bariatric surgery. You need to find that out right away. It either does or it does not. It’s not based on your circumstances. If the answer is “no”, you have to move up your surgery up. If the answer is “maybe”, I would still advise you get it done before July 1st.

Secondarily, you will have to find out if your surgeon is in the new insurance company’s provider network. If not and you have to switch surgeons, then it’s quite possible the new surgeon will require additional surgical workup and your surgery will have to be rescheduled.

Question: If a dependent loses coverge on their parents policy due to reaching the maximum age, is that a qualifying event to pick up coverage under their own employer?

Answer: Yes. See #4

List of Qualifying Events

1. Change in legal marital status, including marriage, death of a spouse, divorce, legal separation and annulment.
2. A change in the number of dependents, including birth, death, adoption, and placement for adoption.
3. A change in employment status of the employee, or the employee’s or retiree’s spouse or dependent, including termination or commencement of employment, a strike or lockout, a commencement of or return from an unpaid leave of absence, a change in worksite, and a change in working conditions (including changing between part‐time and full‐time or hourly and salary) of the employee, the employee’s or retiree’s spouse or dependent which results in a change in benefits they receive under a cafeteria plan or health or dental plan.
4. A dependent ceasing to satisfy eligibility requirements for coverage due to attainment of age, student status, marital status, or other similar circumstances.
5. A change in place of residence of the employee, retiree or their spouse or dependent and the current carrier is not available.
6. Significant cost or coverage changes (including coverage curtailment and the addition of a benefit package).
7. Family Medical Leave Act (FMLA) leave.
8. Judgments, decrees or orders.
9. A change in coverage of a spouse or dependent under another employer’s plan.
10. Open enrollment under the plan of another employer.
11. Health Insurance Portability and Accountability Act (HIPPA) special enrollment rights for new dependents and in the case of loss of other insurance coverage.
12. A COBRA‐qualifying event.
13. Loss of coverage under the group health plan of a governmental or educational institution (a state’s children’s health insurance program, medical care program of an Indian tribal government, state health benefits risk pool, or foreign government group health plan).
14. Entitlement to Medicare or Medicaid.
15. Any other situations in which the group health or dental plan is required by the applicable federal or state law to allow a change in coverage.