tag:www.healthcareshopper.com,2012://6 2012-05-08T20:51:43Z Qualifying for Health Insurance, Affordable Health Insurance, Health Insurance Underwriting, Insuring Children, Health Savings Accounts, COBRA Continuation, and more Movable Type Pro 4.37 tag:www.healthcareshopper.com,2012://6.1181 2012-05-08T14:27:58Z 2012-05-08T20:51:43Z

Question: We own a small business and in Alaska and want to have a baby. There doesn’t seem to be any maternity insurance available though. We do not qualify for the state funded Denali Kid Care. Is there any options...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question:** We own a small business and in Alaska and want to have a baby. There doesn't seem to be any maternity insurance available though. We do not qualify for the state funded Denali Kid Care. Is there any options for us? Thank you. **Answer:** You didn't mention whether you had health insurance or not. If you do not, get some, that would be the first step. Major medical insurance coverage (without maternity) will cover any extraordinary costs connected with having a baby - pretty much everything beyond prenatal tests and normal delivery. Once you are insured against catastrophic loss, you need to start saving for the predictable costs associated with normal delivery, perhaps $10,000. tag:www.healthcareshopper.com,2012://6.1167 2012-04-30T21:27:27Z 2012-04-30T20:03:39Z

Question: I have been working for my company for 11 years I went on maternity leave and then my daughter had health problems and I developed post partum and couldn't return back to work, my company said no problem and...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html Question: I have been working for my company for 11 years I went on maternity leave and then my daughter had health problems and I developed post partum and couldn't return back to work, my company said no problem and continued to pay my full premium ever month I am now back to work and the health insurance company is fighting with my boss and wants to drop me from the plan are they allowed to? Answer: I think I understand what happened and it's really bad luck for both you and your employer. The employer's health plan contract with the insurance company defines a specific length of time employees are to be covered while on maternity leave. Apparently you were out longer than the contracted time. Normally, this is something that would not come to light as long as your employer continued to pay your health insurance premium each month you were out. However, the insurance company will routinely re-certify a health plan and that includes a review of the most recent payroll tax records. If you did not appear on the payroll, you should not have been covered. The insurance company has the legal right not to pay your claim and rescind your coverage. It sucks, but it is what it is.]]> tag:www.healthcareshopper.com,2012://6.1174 2012-04-30T17:57:22Z 2012-04-30T19:04:31Z

Question: Would like to quit my job because my mom is ill and need to take care of her. I have bone on bone with both knees and will need surgery down the road. I have been having steroid injections...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question:** Would like to quit my job because my mom is ill and need to take care of her. I have bone on bone with both knees and will need surgery down the road. I have been having steroid injections for the past 2 years and have been very helpful. My husband is planning on putting me on his plan what complications do you think we will have with getting me coverage? **Answer:** If your husband's health plan is a [group health insurance](http://www.healthcareshopper.com/advice/2007/06/group_or_individual_whats_best.html) plan. You will be able to be added to his plan on the month following your employment termination. Your loss of employer-sponsored group health insurance is a qualifying event that will enable your husband's plan to pick you up without having to wait for his plan's open enrollment period. If your husband's health plan is individual health insurance, you will probably be declined. That will leave [COBRA coverage](http://www.healthcareshopper.com/cobra_health_insurance.htm) as your next option. tag:www.healthcareshopper.com,2012://6.1156 2012-04-06T15:16:38Z 2012-04-10T19:08:05Z

Question: After applying for a medical plan and being accepted, then one month later having heart trouble - will policy pay? Answer: If the insurance company can determine that your heart condition was pre-existing, they will not pay. They will...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question:** After applying for a medical plan and being accepted, then one month later having heart trouble - will policy pay? **Answer:** If the insurance company can determine that your heart condition was pre-existing, they will not pay. They will look at your application with a microscope. For example this is the type of general question that should uncover a pre-existing condition. - "Within the last 5 years have you been advised by a healthcare provider to have, but have not yet had, surgery, treatment, examination, evaluation or test(s) for a medical condition?" If the insurer can produce medical records or claims history that shows that you did not answer accurately, they will deny your medical claim and rescind your insurance - even if your oversight was not related to a heart condition. tag:www.healthcareshopper.com,2012://6.1139 2012-03-17T21:26:14Z 2012-04-24T21:38:40Z

Question: I am a 57 yr old underweight female with a history of controlled asthma and allergies who is mostly healthy. Because of these risk factors, I want to know if underwriting success is higher for a high deductible/low premium...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question:** I am a 57 yr old underweight female with a history of controlled asthma and allergies who is mostly healthy. Because of these risk factors, I want to know if underwriting success is higher for a high deductible/low premium plan vs a low deductible/high premium plan. I want to apply for plans with the lowest risk of being declined. **Answer:** Generally, the probability of being accepted for coverage is improved by choosing a higher deductible plan. There are some variations to the risk assessment with every carrier. The frequency and number of prescriptions, along with any other risk factors will affect the final underwriting decision regardless of the chosen deductible. I suggest, you call our individual underwriting specialist, Erin, at 800-557-5693 and go over your medical history with her. She can determine where you will be treated the most favorably. tag:www.healthcareshopper.com,2012://6.1129 2012-03-07T15:04:03Z 2012-05-06T14:24:26Z

Question: I’m approaching at 65 and my employer is strongly encouraging me to cancel my group coverage and elect Medicare coverage only. Can they do that? Answer: Yes, your employer can “strongly encourage” you to take Medicare coverage when you...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question:** I'm approaching at 65 and my employer is strongly encouraging me to cancel my group coverage and elect Medicare coverage only. Can they do that? **Answer**: Yes, your employer can "strongly encourage" you to take Medicare coverage when you become eligible. It's important that you understand that your employer has been paying at least $500 a month to provide health insurance for you. Medicare will cost $100 per month. Perhaps you could negotiate a reimbursement for the Medicare Part B premium of $100 and an additional $130 - $150 per month for a [Medicare Supplement ](http://www.healthcareshopper.com/health-insurance/individual/medicare.htm)- total cost to your employer is $250 per month and you get virtually 100% coverage. This advice applies only to group health plans with less than 20 employees where Medicare is the primary payor and the group health plan is secondary. In larger groups, Medicare is the primary payor and there are rules that forbid employers from targeting Medicare-eligible employees by providing incentives (financial or otherwise) for them to drop employer coverage in favor of Medicare. As one of our readers, Chris Anderson of Sylmar, CA, pointed out: "The Centers for Medicare and Medicaid Services (CMS), formerly known as the Health Care Financing Administration (HCFA), has confirmed this prohibition many times, and employers should note that CMS may assess a penalty of up to $5,000 for each violation. An employer cannot offer, subsidize, or be involved in the arrangement of a Medicare supplement policy where the law makes Medicare the secondary payer. Even if the employer does not contribute to the premium, but merely collects it and forwards it to the appropriate individual's insurance company, the GHP policy is the primary payer to Medicare." tag:www.healthcareshopper.com,2012://6.1125 2012-03-01T17:28:47Z 2012-03-02T01:03:59Z

Question: Can an employer set up an hra with no group health insurance? Answer: Yes. Companies that want to offer health benefits, but cannot offer group health insurance due to high cost or participation requirements can offer a defined contribution...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: Can an employer set up an hra with no group health insurance? **Answer**: Yes. Companies that want to offer health benefits, but cannot offer group health insurance due to high cost or participation requirements can offer a defined contribution health plan in which they make available monthly contributions that employees can choose how to spend. Employees can use their monthly contribution amount to reimburse their individual health insurance costs and eligible medical expenses. This is just one of many [HRA design options](http://www.healthcareshopper.com/hra_design_options.htm). tag:www.healthcareshopper.com,2012://6.1127 2012-03-01T16:18:31Z 2012-03-02T00:34:25Z

Question: i am adding a person with a pre-existing medical condition on my group policy…will they be accepted? Answer: Yes. In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). This law mandated nationwide, across-the-board guaranteed issue in...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: i am adding a person with a pre-existing medical condition on my group policy...will they be accepted? **Answer**: Yes. In 1996, Congress passed the *Health Insurance Portability and Accountability Act* (HIPAA). This law mandated nationwide, across-the-board guaranteed issue in the small group market - among other things. A small group is defined as an employer group with 2-50 employees. However, insurance companies may charge higher premiums for groups that contain high risks or that have had a history of high claims. In some states, the premium for high-risk groups can be much higher. tag:www.healthcareshopper.com,2012://6.1116 2012-02-28T04:35:29Z 2012-02-27T17:23:33Z

Question: I am the fortunate position that I am covered under my spouse’s insurance at a fantastic rate (group health PPO). I’m about to start a fulltime job which offers an HRA “health plan” as a medical benefit option. If...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: I am the fortunate position that I am covered under my spouse's insurance at a fantastic rate (group health PPO). I'm about to start a fulltime job which offers an HRA "health plan" as a medical benefit option. If I enroll in that plan, will I receive medical care under the PPO as usual and then use the HRA for copays, etc. like I do for an FSA? Or will the HRA qualify as my "primary insurance"? There are levels which are for myself only, myself + spouse, myself + family. My birthday comes first in the calendar year, and will my children also be treated with my insurance as primary if I include my family members? **Answer:** [HRA plans](http://www.healthcareshopper.com/health-insurance/tax-advantaged/hra.htm) are very flexible and I'd have to know more about how your employer's plan is structured to give you a precise answer. But I'll step out on a limb here and say that you can continue to use your wife's health insurance coverage primarily and utilize your employer's HRA plan to reimburse your (and your dependents' if you add them) out-of-pocket medical expenses. This would be a win-win for both you and your employer, though not for your spouse's employer. tag:www.healthcareshopper.com,2012://6.1118 2012-02-27T16:47:02Z 2012-02-27T16:46:14Z

Question: If you loose insurance coverage due to layoff and you are being treated at the time does company have to cover you? Answer: Yes. Upon termination, your company is responsible for making COBRA coverage available to you. However, it...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: If you loose insurance coverage due to layoff and you are being treated at the time does company have to cover you? **Answer**: Yes. Upon termination, your company is responsible for making [COBRA](http://www.healthcareshopper.com/cobra_health_insurance.htm) coverage available to you. However, it is your responsibility to make the entire premium payment to maintain that coverage. If you do so, coverage for your ongoing treatment will be seamless. tag:www.healthcareshopper.com,2012://6.1117 2012-02-27T16:45:23Z 2012-02-27T17:03:40Z

Question: Why can’t i choose to be the primary health insurance for my children if my coverage is better than my husband’s? Answer: It’s not up to you to decide which plan is primary. When dependents are covered on both...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: Why can't i choose to be the primary health insurance for my children if my coverage is better than my husband's? **Answer**: It's not up to you to decide which plan is primary. When dependents are covered on both parents health insurance, Coordination of Benefits (COB) rules come into play. Most states have adopted these rules though they can vary some from state to state. In general, when deciding which parent's health insurance coverage is primary on claims for double-covered dependents, the "**birthday rule**" applies. That is, the plan covering the parent whose birthday falls earlier in the year pays first, and the plan of the parent whose birthday falls later in the year is secondary. And if these parents have the same birthday, the plan covering the parent the longer period of time is primary. tag:www.healthcareshopper.com,2012://6.1122 2012-02-26T21:21:53Z 2012-02-27T16:27:10Z

Question: My husband has a new job. Can I cancel my current health insurance with my company and enroll with his new health insurance plan? Answer: Your husband’s new job is not an acceptable reason for you to opt out...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question:** My husband has a new job. Can I cancel my current health insurance with my company and enroll with his new health insurance plan? **Answer:** Your husband's new job is not an acceptable reason for you to opt out of your own employer-sponsored health plan. You may do that at the next open enrollment period. However, you can't be added to your husband's health plan until his plan's open enrollment period unless you have a "qualifying event" like loosing your coverage through termination. These rules may seem arbitrary are in place to protect employers and insurers against [adverse selection](http://www.californiahealthbenefitexchange.com/challenges/adverse-selection.htm). tag:www.healthcareshopper.com,2012://6.1110 2012-02-21T19:28:57Z 2012-02-22T00:39:35Z

Question: If i am terminated from my job and have to go onto my husbands insurance will my cancer diagnosis be considered pre existing? Answer: Your cancer diagnosis is a pre-existing condition for any insurance you would apply for going...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question:** If i am terminated from my job and have to go onto my husbands insurance will my cancer diagnosis be considered pre existing? **Answer**: Your cancer diagnosis is a pre-existing condition for any insurance you would apply for going forward. If your husband's coverage is group health insurance, your pre-existing condition will not prevent you from becoming insured on his plan. If his coverage is individual health insurance then your cancer diagnosis will cause you to be denied coverage. If that is the case, you have 2 other options [COBRA](http://www.healthcareshopper.com/cobra_health_insurance.htm) and [HIPAA](http://www.healthcareshopper.com/hipaa.htm) health insurance coverage. tag:www.healthcareshopper.com,2012://6.1109 2012-02-21T15:58:27Z 2012-02-22T00:27:29Z

Question: Is an employer responsible for a portion of a terminated individual’s deductible in a group HDHP? Answer: The employer is not responsible for any part of your COBRA premium, but you asked about the deductible which adds an interesting...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question:** Is an employer responsible for a portion of a terminated individual's deductible in a group HDHP? **Answer**: The employer is not responsible for any part of your COBRA premium, but you asked about the deductible which adds an interesting angle. If your employer was reimbursing some portion of your out-of-pocket medical expenses (below the annual deductible) while you were employed, it's possible that there is a [Health Reimbursement Arrangement (HRA)](http://www.healthcareshopper.com/health-insurance/tax-advantaged/hra.htm) in place which would spell out whether former employees are to be covered by the HRA while on COBRA. tag:www.healthcareshopper.com,2012://6.1095 2012-02-11T01:53:13Z 2012-02-13T17:23:33Z

Question: I have a question about the new health care reform. I have a son that just graduated from college and he was on my health insurance where I work (in massachusetts). He will be accepting a new job in...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html Question: I have a question about the new health care reform. I have a son that just graduated from college and he was on my health insurance where I work (in massachusetts). He will be accepting a new job in california but his company has a "waiting period" of 180 days. So my question is can he remain on my health insurance under the "age 26" law even if he is moving to another state and the fact that even tho hie employer offers health benefits..he cannot get the insurance till the waiting period of 180 days has been completed? Thank you in advance. Answer: Health care reform - the Affordable Care Act - allows insured parents to keep their sons and daughters on the their health insurance plan (individual or group) to age 26. Since it's a federal law it affects all states equally. When your son moves to California he can stay on your health plan for a few months until he is covered by his CA employer. However, if you have an HMO in MA it will only cover emergencies in CA. PPO works fine out of state. He can get the in-network coverage in CA if he is careful to select the right provider. If HMO, I recommend he purchase short-term health insurance coverage in CA. It's relatively cheap and easy to qualify.]]>