Healthcare Shopper Advice

Conception Date & Maternity Rider

2009-05-01T07:10:03Z

Question: Hello. My maternity rider became effective March 1 but I found out I am pregnant and based on my last period and the ultrasound I got at the free clinic it looks like I might have conceived the third week in February (just a week shy). Since it is so close to my effective date and there is no way to be 100% sure, how will the insurance company determine my conception date? If they go by the due date then what if the baby ends up being late? How is all this determined? Please help!

]]> Answer: Congratulations on your pregnancy. You should be OK with your insurance. Usually, the date of conception is not the overriding factor. If you did not know you were pregnant when you bought the maternity rider, Your pregnancy will be covered. Most maternity riders have a waiting period so I hope you've checked that out.

Bipolar insurance coverage

2009-04-01T19:53:22Z

Question: My son has bipolar and was in an auto accident a few months ago and hasn't been able to work. He was on his company insurance but lost his coverage. He is looking for a new job but needs health insurance for his monthly therapy and prescriptions. We were going to put him on an individual policy until he gets a job with employer insurance again. The companies we looked at will not cover the bipolar, what can we do? With so many people suffering from mental health issues , it is amazing to me that they don't consider it like any other physical condition.

]]> Answer: As you say, a bi-polar diagnosis makes it virtually impossible to get individual health insurance coverage. Some cases (on a single medication, no hospitalizations), can be covered by Aetna.

12 Weeks Pregnant, COBRA expires in July

2009-02-28T16:29:51Z

QUESTION: My wife is 12 weeks pregnant, and her COBRA insurance expires in July (7 mos. into pregnancy). My COBRA insurance also expires in July. Will she be able to get a different insurance policy?

]]> ANSWER: Yes. Once your COBRA coverage expires, you and your wife will qualify for guaranteed issue HIPAA coverage.

Getting Healthcare Ins after your Cobra Expires

2009-02-03T06:49:14Z

Question: My Cobra will expire on 4/30/09 and I will not turn 65 until Aug of 2010. Can I contact someone to continue Cobra or an Individual plan? Should I contact the current carrier I have had for the past 15 months?

]]> Answer: When your COBRA health insurance coverage expires you will qualify for guaranteed issue health insurance coverage under the federal HIPAA law.
Most health insurance companies who market individual health insurance offer HIPAA qualified coverage. HIPAA plans are usually high deductible PPO plans at a substantial mark-up over the standard rate for a "healthy" applicant. The idea being that HIPAA applicants are a greater risk as a group. You may be able to purchase a HIPAA plan from your current insurer, but can shop for HIPAA plans from any other carrier in your state.

COBRA & Individual Family Plan

2009-01-19T19:16:54Z

Question: My husband was laid off from his job. We are offered the COBRA coverage from his previous employer. I will be electing the COBRA coverage because I am 8 months pregnant. My husband and son are going to look into getting an individual family plan instead of electing COBRA through his prior employer.

Is this an option for our family? Can my husband and son get an individual family plan while I am on COBRA along with our newborn (once he is born)? After the birth, and if everything is fine with both myself and newborn would we be able to also change to an individual family plan?

]]> Answer: Since your husband's job was the source of your health insurance coverage, your husband will have to elect COBRA for his wife to be covered. Yes, when the baby is born he/she will be covered on the COBRA plan.

You son could start on his own health insurance plan now, but since you will deliver in a month he might as well go on COBRA with the rest of the family. Once your baby is born, shop for a health insurance plan for your whole family.

Preexisting Conditions and COBRA

2008-11-17T19:54:06Z

Question: My husband has been offered a job with a good company.They have offered to pay for cobra for the 90 day waiting period until his new insurance kicks in. My question is, my husband is in pain managment where he gets steriod shots and is administered medications from a previous back surgery over a year ago. I myself have high blood pressure.This new insurance company United Health Care, has told me that he must be evaluated by the underwriters to see if they will cover these preexisting conditions,if he denied we will be out of luck. Is there anything that we can do, or any resouce that we can contact to get information. Thank You

]]> Answer: I'm going to have to redefine your question because you have intorduced complications by mentioning COBRA.

1. The only way your husband can qualify for COBRA coverage would be from a previous job where he had group coverage. If he is within 62 days of leaving that coverage, he may qualify for COBRA coverage. If that is the case, his preexisting health conditions do not matter. He can be covered.

2. More likely, his new employer is offering to pay for individual health insurance for your husband and you during the group waiting period. Based on what you have told me about his health history, UnitedHealthcare will probably offer your husband individual health insurance with an exclusion for any care regarding his back. That might be the best you can do for the next three months.

Continuation of MediGap Coverage

2008-10-24T13:55:01Z

Question: I am retired and on Medicare with a BC/BS Medigap policy which continues to be administered by my former employer. I pay about $100/month for this coverage. If my previous employer discontinues this insurance, will I have the same COBRA-HIPPA options for continuation of the MediGap coverate that apply in layoff situations to persons who are not yet eligible for Medicare?

]]> Answer: No. HIPAA laws do not apply to Medicare Supplement insurance. You will have the option to continue your Medigap policy, by taking over payment of the entire premium.

Layoff of Person with Uninsurable Dependent

2008-10-24T13:49:08Z

Question: A number of years ago, we had a layoff from my long time employer; only one of the senior staff remained. That person has an autistic child. Recently, I have been told that he could not be terminated because he had an uninsurable dependent. Is that true?

]]> Answer: From my expertise in health insurance, I would say no. I have never seen a situation where an employee could not be terminated because of their health or a dependents health.

Having said that, you should ask an employment lawyer.

Individual Health Insurance for wife

2008-10-23T18:29:00Z

Question: I have recently changed jobs where the health insurance is very cheap for me but very expensive to add my wife. I'd like to get a private plan for her, but she takes several medications that could make it prohibitive. Is there some obvious option for this situation? She's otherwise healthy and I would consider high deductibles.

]]> Answer: Unfortunately, there is no obvious option for your wife. If she cannot qualify for individual health insurance because of preexisting medical conditions (her prescription medications), your only option is to enroll her on your employers group health plan.

Income Too High to Qualify for State Childrens' Health Insurance

2008-09-18T13:28:16Z

Question: I am a single parent with a job that does qualify my children for all kids coverage under the guidelines, however, when you add my child support into our income, we have too much. My shopping around is getting us nowhere fast, insurance comparable to bcbs is ranging from $590.00-$900.00 a month. What can you suggest? I really had hoped that bcbs all kids would cover them.Thank you.

]]> Answer: If you cannot afford health insurance for the whole family you can analyze your family's risks and protect yourself from the biggest risks with the least amount of premium. So let's take a look at some scenarios.

If one or more of your children are still infants, purchase health insurance for the infant only. That child will need to see the doctor frequently for well-baby visits and is more at risk for minor illnesses than your older children. Buy a plan thet covers preventive care and doctor visits for a copay for that child. It will cost you about $100 monthly. If that's all you can do right now. So be it.

Let's say one of your children has a chronic illness - like Asthma. That condition could lead to a very expensive emergency room visit. You could cover that child with a low-cost high-deductible health insurance plan for about $60 per month. If he or she has an emergency room visit without insurance, your cost might be $25,000, with cheap insurance your portion might be as low as $2,000. If that's all you can do, just do it.

You can insure all your children against the most expensive risks (hospitalization) for a lot less money than you mentioned - $590 minimum (assuming you don't have 10 kids.) You were probably looking at plans that cover doctor visits, diagnostic exams, etc. These are not high-dollar expenses and health insurance plans that include them are too expensive for you. Check locally for "free clinics" or low cost community clinics that can provide your kids with treatment of minor illnesses and immunizations.

Hope this helps.

Denied for Kaiser Permanente Individual Health Insurance

2008-09-05T02:11:20Z

Question: My mom is currently insured under COBRA/CAL-COBRA (which expires Oct. 1, 2008). She applied for the "Kaiser Permanente Individuals and Families" health care coverage and was denied coverage. The reasons being: she has High Cholesterol, was diagnosed with tendonitis of the shoulder and bursitis of the hip (she gets steroid injections to relieve the pain) and was diagnosed with bilateral carpal tunnel syndrome with surgery performed on the left hand in April 2007. Can you please suggest an affordable health coverage plan that will not deny her? She is 64 and will be 65 in 2009.

]]> Answer: Your Mom qualifies for HIPAA guaranteed coverage provided she has exhausted her CAL-COBRA coverage. HIPAA coverage is offered by most insurance carriers. HIPAA guaranteed plans are usually lighter on benefita and higher than standard rates, but she cannot be denied coverage regardless of her health. Given that she has a year or less until she 's covered by Medicare, it's a no brainer.

Need cheap birth control pills

2008-09-04T20:14:27Z

Question: I'm 21, and just moved out of state and am not on my moms health insurance anymore because im taking a semester off school. Is there anyway I can get health insurance so I can afford cheaper birthcontrol?

]]> Answer: If you are only concerned with the cost of your birth control pills, you don't need to buy health insurance. Get a prescription from your doctor for generic birth control pills. Ask for a 90 day supply per refill. Then go to Wal-Mart or Wallrgeens (there may be other discount sources but I know these for sure) to fill the prescription. You will pay $12 for a 3 month supply.

Court Ordered Medical Coverage

2008-08-14T20:48:15Z

QUESTION: I am required by court order to provide insurance for my child. Do I have to go on my group's policy or can I just enroll my child?

]]> ANSWER: It's possible that a court could specify that you use your employer group policy to cover your dependent child. However, that would be exceptional. We have many clients who cover their children on individual health insurance policies to satisfy a court order.

Uninsurable after Cancer

2008-06-19T16:04:13Z

Two questions: I had a sarcoma cancer removed 7 yrs. ago and have tried to get life insurance (additional to my small policy with my employer) but have been denied. Will I ever be insurable?
I'm a state employee of 20+ yrs. with 2 children and the possiblity of a layoff, which would cancel my current health and life insurance. Would we as a family (children & husband) be eligible for health insurance? And would we be required to have physicals as I did with the life insurance application? Thank you...

]]> Answer: As far as health insurance goes, you will be insurable once you have 10 years free of sarcoma symptoms or treatment. I don't know what the underwriting guidelines are for life insurance.

If you should loose your group health insurance, you will qualify for COBRA coverage for 18 months. Take it. You will have no other options at that time. Your children and husband could qualify for individual health insurance based on their individual health conditions. Unless they are rated up due to prexisting conditions, the individual health insurance will be cheaper for them than COBRA. When your COBRA coverage expires, you will qualify for guaranteed issue coverage under the HIPAA laws. If you choose not to take the COBRA when you are eligible, you will also loose your HIPAA option. Once 10 years has passed since you had the sarcoma, you may then qualify for health insurance at a lower rate than the HIPAA guaranteed coverage.

Sound dismal?. Not really. You're lucky. If you had no group health insurance right now, all of your COBRA and HIPAA guaranteed options would be off the table. If you loose your job, you will have health insurance options, even if your coverage will be more expensive than it would be without the sarcoma history.

Daughter turning 19 in a few months

2008-06-03T18:49:29Z

Question: BCBS of Illinois only covers dependent children until 19 years of age. I need to find health coverage with bi-polar, personality disorder, PTS and takes meds. She currently is not employeed.

]]> Answer: As you know, your daughter will no longer be covered on your family health insurance coverage once she turns 19. She will need her own insurance coverage at that time. If she has been diagnosed with both Bi-Polar Personality Disorder and Post Traumatic Stress Syndrome she will not qualify for individual health insurance.

Illinois is one of the states with a Major Risk Insurance Pool. The plan is called ICHIP for Illinois Comprehensive Health Insurance Plan. Find the link to the ICHIP website at HealthcareShopper's Risk Pool page.