tag:www.healthcareshopper.com,2012://6 2012-02-09T16:57:07Z 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://6.1090 2012-02-09T16:15:55Z 2012-02-09T16:57:07Z

Question: Can grandparents cover a baby with insurance? Answer: If you mean, can you add your grandchild to your individual or group health insurance coverage the answer is no unless you are the child’s legal guardian. You certainly can purchase...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: Can grandparents cover a baby with insurance? **Answer**: If you mean, can you add your grandchild to your individual or group health insurance coverage the answer is no unless you are the child's legal guardian. You certainly can purchase individual coverage for your grandchild - referred to as [child-only health insurance](http://www.healthcareshopper.com/health-insurance/individual/child.htm). Unfortunately, due to the *law of unintended consequences*, child-only coverage is impossible to get in most states. The Affordable Care Act (ACA) legislated that no exclusions of coverage would be allowed for children through age 18. The intent of the law was to make health insurance for children guaranteed-issue - meaning they can't be turned down because of pre-existing conditions.In most states child-only health insurance is no longer available (California being one of the exceptions) because the insurers refuse to comply with the law's intent. Quite possible, this stalemate will continue until January 2014, when all health insurance is guaranteed issue. tag:www.healthcareshopper.com,2012://6.1089 2012-02-09T16:15:31Z 2012-02-09T16:37:25Z

Question: Does my employer have to pay part of my health insurance in California? Answer: Yes, but only if your employer already sponsors a group health plan for its employees. If so the law says, they must pay 50% of...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: Does my employer have to pay part of my health insurance in California? **Answer**: Yes, but only if your employer already sponsors a [group health plan](http://www.healthcareshopper.com//health-insurance/small-business.htm) for its employees. If so the law says, they must pay 50% of the employees' premium for the lowest priced plan available. If your employer does not already have a group health plan for its employees, they are not required to pay any part of your [individual health insurance](http://www.healthcareshopper.com/health-insurance/individual/index.htm) expense. tag:www.healthcareshopper.com,2012://6.1085 2012-02-08T15:32:06Z 2012-02-09T00:20:02Z

Question: I have a healthcare reinbursement account. Our son is 24 and on our insurance. We pay for his out of pocket medicine expenses($330 a month after insurance) because he does not make enough money to afford these medications. We...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: I have a healthcare reinbursement account. Our son is 24 and on our insurance. We pay for his out of pocket medicine expenses($330 a month after insurance) because he does not make enough money to afford these medications. We do not claim him as a dependant on our tax return. Can I use my reinbursement account for his medical expenses if we are paying for them? **Answer: ** Your health reimbursement arrangement should allow the reimbursement of prescription drugs for your son. The fact that he is covered on your health plan is key in determining his eligibility fro reimbursement. The fact that you do not claim him for tax purposes is not a factor. I can't say for certain because HRAs are very flexible and it is possible (though highly unlikely) that prescription drugs are not included as a reimbursable expense on your specific plan or that dependents are specifically excluded. tag:www.healthcareshopper.com,2012://6.1081 2012-02-07T03:52:35Z 2012-02-07T17:51:03Z

Question: I am in middle management for a large industrial company and pay for a family plan that covers me and my two children. My wife is a teacher whose school board provides single coverage for her (for a fee)...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: I am in middle management for a large industrial company and pay for a family plan that covers me and my two children. My wife is a teacher whose school board provides single coverage for her (for a fee) that's nowhere near as good as mine - she can't opt out. My employer recently announced that effective May 1, if any of us have a spouse with health care coverage, we need to enroll our children on their plan and be covered only as "single" on our own existing plan. No explanation was given although I suspect that in my industry which is predominantly male, the company wants to save costs by not covering child delivery and other costs not directly incurred by the actual employee. Switching to my wife's plan would be a) more expensive and b) provide less coverage than my children have now. Is this legal? **Answer:** Employers increase employee cost-sharing to order to deal with the ever increasing cost of providing health care benefits for its employees. Generally, this occurs after the employer has absorbed much of the cost increases themselves. Usually this cost sharing takes the form of requiring a larger employee premium contribution or a reduction in benefits. As far as I know, your employer has the right to insist that a spouse or dependent must opt out of your coverage if they have access to coverage through their own employer. Requiring you spouse to cover your children on her employer's health plan doesn't seem fair. There is not yet (2014) any law that says employers have to provide health insurance at all, but if they do they must follow federal ERISA regulations that among other things govern "fairness" in the administration to the plan. For a more definitive answer, you will have to ask an HR attorney. tag:www.healthcareshopper.com,2012://6.1073 2012-02-02T20:29:31Z 2012-02-02T23:35:40Z

Question: I have an individual health insurance policy paid for by my employer. I also have the benefit of being on my husband’s health insurance through his employer. I always thought that MY coverage was primary over the coverage provided...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question:** I have an individual health insurance policy paid for by my employer. I also have the benefit of being on my husband's health insurance through his employer. I always thought that MY coverage was primary over the coverage provided by my spouse's employer. But my carrier said group policies are always primary over individual policies. Is this true? (South Carolina). **Answer**: Coordination of Benefit Rules were codified by the National Association of Insurance Commissioner in 1986 and each state uses this model with some modifications. The rules cover how the primary payer is determined when an insured employee or dependent has double coverage. For example the rules state that the group plan covering the insured as an employee pays first. To determine who pays first on dependent children's claims, the plan covering the parent whose birthday is earlier in the calendar year is primary. The Coordination of Benefits endorsement on group health policies does not apply to [individual health insurance](http://www.healthcareshopper.com/health-insurance/individual/index.htm) policies so they generally pay their full benefits regardless of other group health policies in force. But there are variations between states, it is important that you review the provisions of your individual health insurance policy because they will sometimes include their own provisions about other insurance. tag:www.healthcareshopper.com,2012://6.1072 2012-02-02T05:55:07Z 2012-02-03T00:08:25Z

Question: I’m 9.5 months pregnant and currently covered under my husband’s group insurance policy. It’s very expensive, but we obviously needed the maternity coverage, so we opted for adding me to his rather than me getting individual insurance. We’d planned...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: I'm 9.5 months pregnant and currently covered under my husband's group insurance policy. It's very expensive, but we obviously needed the maternity coverage, so we opted for adding me to his rather than me getting individual insurance. We'd planned on just adding the baby to our plan, but just found out that the cost of this with our current plan is prohibitive and we can't downgrade the plan for another 9 months (during open enrollment). I have done some research and think the best bet is for him to drop me from his plan 1 month after the baby is born (so my postnatal visits are covered) and for me and the baby to get individual insurance (which is still substantially cheaper than the family plan through his work) as soon as she's born. My question is about the timeline with the birth and insurance. Since we wouldn't be adding the baby to our existing plan and instead starting a new plan (which it looks like I can't do till she's born and we have her birth certificate), will we have trouble getting coverage? I know we have 30 days to add her to our group plan, but if we're opening up a new plan, how does that work? I know it can take up to a few months to get new coverage and obviously can't go without coverage for my child. We're in Florida and I have no health concerns (other than currently being pregnant!). I'm nervous since we don't have much time to sort this out. Thanks for your help! **Answer**: I'm guessing at 9.5 months pregnant you don't have much patience for a long-winded answer so I'll get right to the point. You can apply for individual health insurance - both you and the child together - about 2 weeks after the baby is born. You will need a copy of the initial physical exam for the baby. If the baby has no health issues, you should be able to get coverage starting within 30 days of the baby's birth. Your group health insurance will cover the baby for the first 30 days after birth. If you have the energy, [click here](http://www.healthcareshopper.com/webform/) to start shopping for a health plan now - just enter a birth date of a month ago for your child. tag:www.healthcareshopper.com,2012://6.1070 2012-02-01T20:47:25Z 2012-02-02T22:02:54Z

Question: My company pays for half of my premium and I pay the other half along with full coverage for my three year old daughter...the deduction for my health insurance had increased...I told my employer that I would like to...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: My company pays for half of my premium and I pay the other half along with full coverage for my three year old daughter...the deduction for my health insurance had increased...I told my employer that I would like to opt out of the company policy and purchase individual insurance, because I could get a better policy at a cheaper rate and they advised me that I cannot cancel my insurance until open enrollment in November. I was never advised that my premiums were increasing, there was not a meeting, email, nothing letting me know. Can my employer force me to stay on their company plan until November? **Answer**: Yes. Apparently your employer did a lousy job of communicating the increase in your health insurance contribution back in November when you could have opted out. Employees should have the option to decline medical coverage or to purchase individual health insurance as long as their decision does not affect the medical rates of those remaining in the plan. Opt-Out provision are restricted to open-enrollment periods because it was determined that about 20 percent of a plan's participants generate 80 percent of the claimed costs in any given year. In most cases, those who opt out of a medical plan are the healthier population; employees expecting high expenses prefer the extra coverage. Since employees with more medical needs tend to stay in the plan, when employees opt out there are fewer premium dollars coming into the plan, but claim and administrative costs do not go down in the same proportion. This results in higher premiums for those remaining in the plan. That's why restrictions are in place for right to opt out. tag:www.healthcareshopper.com,2012://6.1069 2012-01-31T20:19:58Z 2012-01-31T21:35:02Z

Question: My employer offers health insurance to me at no cost to me. My husband also has me covered through his insurance at his place of employment. I have been told that my insurance through my employer has to be...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: My employer offers health insurance to me at no cost to me. My husband also has me covered through his insurance at his place of employment. I have been told that my insurance through my employer has to be my primary. I want to opt out of my insurance through my employer and only have my husband insurance, but my employer is telling me that I can not opt out and that I have to take the insurance. Is this right? The board pays our insurance, but I would rather them put my board paid money into and annuity. **Answer**: The responsible thing to do would be to take the coverage your employer is offering and cancel the coverage being offered through your husband's employer. Your sense of entitlement is especially astonishing at a time when many people lack good health care and some can't get it at all. tag:www.healthcareshopper.com,2012://6.1068 2012-01-30T17:39:56Z 2012-01-31T21:33:10Z

Question: My employer has just sent me an email stating he will no longer cover the insurance premium for my spouse and my cost for myself will increase. He states this is effective in March. Is this legal? This is...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: My employer has just sent me an email stating he will no longer cover the insurance premium for my spouse and my cost for myself will increase. He states this is effective in March. Is this legal? This is a small Colorado employer. **Answer**: Yes. Your employer was never required to cover your spouse and did so voluntarily. If an employer offers a group health plan, he or she is required to be fair. For example, it the employer offers coverage for spouse or other dependents, he or she must offer like coverage to all employees of that class, e.g. hourly, salaried, management, etc.. From what you say, your employer is making a choice to no longer contribute to dependent coverage for all enrolled employees effective on the March 1 plan renewal date. That is his right and probably a necessity for the health of the business. Employer sponsored health insurance costs have increased by 50% over the last 5 or 6 years. tag:www.healthcareshopper.com,2012://6.1064 2012-01-27T01:36:25Z 2012-01-29T01:05:29Z

Question: I moved my family from Virginia to Alaska last week. We have an individual family policy (not group) from Anthem BCBS Virginia. My intention was to keep the Virginia policy and apply for a new policy when we got...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: I moved my family from Virginia to Alaska last week. We have an individual family policy (not group) from Anthem BCBS Virginia. My intention was to keep the Virginia policy and apply for a new policy when we got here. Since arriving I have not been feeling well. It may be nothing but my concern is that if I visit a doctor and there is something wrong I may not be able to get a new policy. Is this a ligitimate concern and what if any recommendations do you have? Thank you!! **Answer:** Your Anthem Blue Cross Blue Shield of Virginia policy covers you in Alaska. As long as you get medical services from a provider who is in the Premera Blue Cross of Alaska network, your coverage in Alaska will be the same as they would have been in Virginia. If you have something wrong, get treatment. It could be something that would become serious if not treated now. Go see a doctor! Normally, your current policy will cover you in Alaska for months (six months is probably the limit). You should apply for coverage with Premera Blue Cross in Alaska if you live there on a more permanent basis. If you have developed a serious medical condition in the meantime and do not qualify for individual health insurance with a new carrier, there are other options like [HIPAA](http://www.healthcareshopper.com/hipaa.htm) and [PCIP](http://www.healthcareshopper.com/health-reform/pcip.htm). tag:www.healthcareshopper.com,2012://6.1062 2012-01-24T23:23:26Z 2012-01-24T23:33:11Z

Question: Why can’t employer reimburse individual insurance premiums? Answer: Employers can reimburse individual health insurance premiums, but the reimbursement is not tax deductible for the employer and is taxable as income for the employee. The employer would have to establish...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: Why can't employer reimburse individual insurance premiums? **Answer**: Employers can reimburse individual health insurance premiums, but the reimbursement is not tax deductible for the employer and is taxable as income for the employee. The employer would have to establish a[ Health Reimbursement Arrangement (HRA)](http://www.healthcareshopper.com/health-insurance/tax-advantaged/hra.htm) in order to enjoy the same tax advantages of group health insurance - deductible premiums and pre-tax income for the employee. tag:www.healthcareshopper.com,2012://6.1061 2012-01-24T23:02:33Z 2012-01-24T23:19:46Z

Question: Can you opt out of mandatory maternity coverage in California if dont want it? Answer: Not if you are covered by a group health insurance plan. California law requires all employer sponsored group health plans to include maternity coverage....

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: Can you opt out of mandatory maternity coverage in California if dont want it? **Answer**: Not if you are covered by a [group health insurance](http://www.healthcareshopper.com//health-insurance/small-business.htm) plan. California law requires all employer sponsored group health plans to include maternity coverage. While it seems illogical for a single male or an older female to be required to pay the extra costs associated with insuring for maternity coverage when they will never use the benefit, it is one of the basics that makes insurance work, that is: those with no claims finance those with claims. It makes the maternity benefit affordable for all those who need it. In the [individual health insurance](http://www.healthcareshopper.com/health-insurance/individual/index.htm) market, many plans are available without the maternity benefit. This makes those non-maternity plans more affordable, but also makes those plans with a maternity benefit very expensive for the few who require it. tag:www.healthcareshopper.com,2012://6.1055 2012-01-19T04:01:42Z 2012-01-19T04:19:15Z

Question: Does Obamacare provide maternity for married dependents? Answer: The Affordable Care Act (ACA) includes several categories of essential benefits to set a benefits floor for all health insurance plans from 2014 going forward and maternity and newborn care is...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: Does Obamacare provide maternity for married dependents? **Answer**: The Affordable Care Act (ACA) includes several categories of [essential benefits](http://www.californiahealthbenefitexchange.com/challenges/essential-health-benefits.htm) to set a benefits floor for all health insurance plans from 2014 going forward and maternity and newborn care is one of those categories. But I think you may be asking another question. It sounds like your married son or daughter is covered under your health insurance policy and you have a grandchild on the way. We don't know yet how that situation will be covered in 2014, but today, the maternity and delivery costs will not be covered by your health insurance. tag:www.healthcareshopper.com,2012://6.1054 2012-01-19T03:41:49Z 2012-01-19T03:58:02Z

Question: If you are treated for an illness in the last few days of December and have to have additional treatment in January of the following year for the same illness do you still have to meet your deductible again....

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: If you are treated for an illness in the last few days of December and have to have additional treatment in January of the following year for the same illness do you still have to meet your deductible again. **Answer**: Generally, the annual deductible resets on January 1st. But you may want to contact your health insurance company to ask about "fourth-quarter roll over." Some health insurers will allow dollars paid toward your deductible in the final months of 2011 to "roll over" or count toward your 2012 annual deductible. This can give you a head start toward meeting your deductible in the new year. tag:www.healthcareshopper.com,2012://6.1053 2012-01-17T21:26:57Z 2012-01-17T23:14:56Z

Question: We purchased a private plan through Golden Rule / United Health Care in 2009. They excluded coverage for my 7 year old son’s ears for life. Anything at all to do with his ears. Is this considered a grandfathered...

Phil Daigle http://www.healthcareshopper.com/blog/2006/08/about_phil_daigle.html **Question**: We purchased a private plan through Golden Rule / United Health Care in 2009. They excluded coverage for my 7 year old son's ears for life. Anything at all to do with his ears. Is this considered a grandfathered plan and can they still deny coverage for his ears? **Answer:** The Affordable Care Act (ACA), or Obamacare depending on your politics, legislated that no exclusions of coverage would be allowed for children's (through age 18) health insurance. Most sane individuals would see the intent of the law was to make health insurance for children guaranteed-issue - meaning they can't be turned down because of pre-existing conditions. The insurance industry chose to interpret the law differently with the result that in most states [child-only health insurance](http://www.healthcareshopper.com/health-insurance/individual/child.htm) is no longer available (California being one of the exceptions) because the insurers refuse to comply with the law's intent. I guess your son's health insurance carrier will keep doing what they want until forced not to.