O/T moving from group to private insurance

bonnieboo · 11-30-2006, 01:19 PM

How does this work? What do I need to know, and what do I need to do now to keep us insured? What special concerns do I bring with me to this process as someone with a pre-existing condition? Is it true that if I don't let my coverage lapse, insurance comapanies cannot reject me based on this? What are the costs? Is there anything else I should now?

TIA! You rock moms!

b

sazzifrazz · 11-30-2006, 01:22 PM

I don't know a whole lot about it, but I had a co-worker whose husband owned his own company therefore paid out of pocket for insuance. They had Cobra which cost them $900 a month for a family of 3. that was here in MA so it might be cheaper elswhere.

wyatt9673 · 11-30-2006, 01:37 PM

Bonnie - I am almost positive that you are correct in the assumption about pre-existing conditions. I know that when I switched jobs (and therefore insurance) I had no problems regarding pre-existing conditions - including infertility & PCOS. The insurance company said that as long as my coverage never lapsed, I would be covered.

11-30-2006, 01:49 PM

Quote:

Originally Posted by wyatt9673

Bonnie - I am almost positive that you are correct in the assumption about pre-existing conditions. I know that when I switched jobs (and therefore insurance) I had no problems regarding pre-existing conditions - including infertility & PCOS. The insurance company said that as long as my coverage never lapsed, I would be covered.

This is my experience as well. I've only changed once or twice, but as long as I could prove continuous coverage pre-existing conditions weren't an issue for me. Be sure you get a certificate of credible coverage for your group coverage (some send them on cancellation) for your future insurer.

shorty1kanobi · 11-30-2006, 04:15 PM

Hey Bonnie - you know the best way to reach me if you have more questions, but here are a few tips for you.

1. The benefit to group coverage over individual is that the risk is spread over more people and the hope is to keep the cost down. With individual coverage there is usually less coverage and the rates are based on your health history specifically.

2. While they can't deny you based on those preexisting conditions, they can certainly charge you based on them. SO, when getting quotes be very clear about your health history and ask in advance about what kind of surcharges you're looking at to determine if it is worthwhile. Unless you are talking DIRECTLY with a company underwriter, the answer to that should be "I'll take this information down and call to ask them." If they tell you "about 20%" ask that they call the underwriter to ask about the conditions specifically. Most agents are provided with a book that classifies certain conditions, but PCOS is a mystery to most agents (or dr's for that matter) and so your best chance of getting an accurate quote is asking them to find out for sure.

3. Don't change your current coverage before confirming you have absolutely been approved for the other. Unlike auto insurance, for example, health insurance agents don't have the authority to bind the coverage - the app has to be submitted, reviewed, approved and you have to accept it before you have coverage.

4. Regarding Cobra - You have 90 or 120 days (I'm a bit rusty) to determine whether you want coverage, and you can determine at any point along that line that you want to continue it and then pay retroactively but you become responsible for all the premium and group rates typically suck no matter where you are. Coverage through cobra can usually be continued for 18 months.

5. Deciding whether to switch - some people find that individual plans are best for them, some switch to the other spouse's company instead. Another thing you MIGHT want to consider is what is usually referred to as an HSA. Basically they pair a high deductible health insurance plan with a savings account. The idea is that you put at least enough in the medical savings account to cover your deductible. YOu can, however, put more in there with tax benefits, and use that money for ANY medical expenses including some that aren't covered by your health plan, such as infertility treatments, dental care, eye surgery, etc. (Just no boob implants, hot tubs, stuff like that) If you do that you'll want to meet with someone who REALLY understand them.

Again, if you have more ?'s you know where to find me.

~Traci~ · 11-30-2006, 04:18 PM

Be careful which company you choose in TX b/c the laws for individual/family insurance here are horrible! Also, if you want to TTC or become pg again, there aren't too many companies that will cover you (for either IF or maternity). I think I found one (I can't remember what company it was) but you had to pay a ton more & have the coverage (paying the extra) for at least a year until they would cover pgcy.

BCBS is ok here but they don't cover pgcy. I had UHC but I don't think they do indivdual policies (I had a rollover from my old employer). We looked in to Unicare, they cover maternity but the coverage is horrible. It was almost better to have no coverage at all. All the things I learned when we moved from MA (which has some great insurance laws) to TX (a state that doesn't have such great laws....).

I've never had a problem w/ pre-existing conditions, etc. There should be an an 18 month law (at least I think it's a law). As long as you've had health insurance (any) for at least 18 months continuous they can't have a pre-existing condition clause.

Good Luck!
Traci

lawgirl1998 · 11-30-2006, 04:37 PM

B, I'll ask a friend of mine that's in your boat here. She found ins to cover her and her twins, but still couldn't afford to put hubby on the ins. and I'm pretty sure she wasn't able to find maternity, but she can probably tell me what companies you might want to consider.

And yes, TX has crap ins laws, even for group insurance.

bonnieboo · 11-30-2006, 04:40 PM

Quote:

Originally Posted by ~Traci~

I had UHC but I don't think they do indivdual policies (I had a rollover from my old employer).

Okay..We're currently covered by UHC. I'm hoping to resign and work from home. What is this rollover of which you speak, lol?

Shorty, Thanks Thanks Thanks! I will likely have more questions, and will be in touch.

b

julie007 · 11-30-2006, 04:52 PM

DH was laid off back in August and we went thru this. The Cobra thru Cigna was ungodly $1063 per month for the family!!!! I am in FL and got BCBS PPO Blue Options. We pay $463 per month and it is full coverage. I could have gotten a less expensive one but I just wanted to go to the doc and pay $20 and be done with it without having to worry about meeting the yearly deductiable first. I do have maternity but is a 50/50 plan (I think this is automatic with the PPO). If I had wanted the HMO that did the regular maternity it would have been an extra $400 per month! With not being sure If we will even need this the 50/50 was smarter anyway. Plus the HMO you had to wait 12 months and the PPO was after 30 days. I didn't put PCOS down as a pre-existing because in my opinion it isn't. They did their research and came back and we were approved. I have had two car wrecks in the past two years and nothing came back. I think it all has to do with if you have had continous coverage or not.

You have 90 days to take the Cobra or not.

~Traci~ · 11-30-2006, 08:01 PM

Quote:

Originally Posted by bonnieboo

Okay..We're currently covered by UHC. I'm hoping to resign and work from home. What is this rollover of which you speak, lol?

I'll PM you the info that I have about it. You work for a large company which would provide COBRA, right? I worked for a very small company that didn't have to provide COBRA. This was like COBRA. I'm not sure if anyone that's w/ UHC can get it. I'll tell you though, my premium TRIPLED for the same exact coverage that I had just b/c I wasn't under my employer anymore.

bonnieboo · 11-30-2006, 08:19 PM

Thanks Traci! Very helpful!

You know, to get briefly political, if this administration supported entrepreneurship as much as it claims it does, it wouldn't cost you your life savings to buy insurance after you leave the grind and try to start your own business.

peaches205 · 11-30-2006, 09:12 PM

Quote:

Originally Posted by bonnieboo

You know, to get briefly political, if this administration supported entrepreneurship as much as it claims it does, it wouldn't cost you your life savings to buy insurance after you leave the grind and try to start your own business.

Well, yea. This admin or any other in recent memory, quite frankly. Just the fact that so many kids are uninsured is enough to make my blood boil. Okay, shut me up! That would get long and U-G-L-Y.

BUT, I did want to wish you well on your new endeavors. I hope it's exactly what you and your family need.

Hope-things-work-out-for-you happy dance for Bonnie! Change can be reeeeaaaally good. Trust me. I just did it, too!

Zebra · 11-30-2006, 11:15 PM

Just a quick note: you have 60 (!) not 90 days to elect COBRA (check here for more details if you are considering COBRA)

You should contact UHC directly and ask them for roll over plans from group to direct. They can do that from you rcurrent insurance or from COBRA as well, because technichally you still have the same insurance once you are on COBRA you are just paying out of your nose for it instead of getting the employer to chip in. Just make sure you employer has to offer COBRA.

I am not much help otherwise, because as we have already established in another thread, I am spoiled Massachusetts resident when it comes to insurance, and no idea about TX cause we oly have one employee in TX and he is insured through MA.

Best of luck though for the research and the endeavour!

Zebra

PaintedDaisy · 12-01-2006, 03:08 AM

Yup, you have 60 days to elect to use COBRA. It's expensive because you are footing the entire bill and the company you work for is not subsidizing anything. Expect equivalent coverage under and individual policy to be AT LEAST that much, but likely much more than that. When I looked into COBRA coverage after leaving a job a few years ago, it was $400/month just for me. That was pre-PCOS diagnosis, no kids, no family, and with terrible benefits.

At least with COBRA, though, coverage is retroactive. Meaning you can elect to have coverage on day 59 and make your payment. . .and any medical treatment you had in the previous 59 days would be covered as if you had elected coverage on day 1. I used this advantage by not actually electing to have COBRA coverage. I got the paperwork and was ready to send it in, but didn't right away. I did this because my new job had health insurance, I just had to wait 2 months before coverage began. So. . .I took a gamble. If nothing catastrophic happened in that 2 mos, I could save myself $800. If I got hit by a bus and had huge medical bills, I'd just send him my $800 and have everything covered.

Another perk is that if you're eligible for COBRA coverage, regardless of whether you elect to take it, it does NOT count as a "gap in coverage". In other words, those 2 mos I gambled did not count as a gap. But, of course, you have to get coverage again right when the COBRA period is set to expire, or it will be considered a gap.

Also, eventhough you have 60 days to sign up for COBRA, you can continue with COBRA coverage (at the high premiums) for quite some time. I think it depends on a variety of circumstances, but it could be anywhere from 6 mos to 18 mos, or more. So if you have trouble finding an affordable individual policy, stick with the COBRA until you shop around and find something because as long as you're carrying COBRA, you're not considered uninsured.

Just a few things to consider.

packerfan · 12-01-2006, 11:25 AM

What sucks is insurance companies can insure a person in 1 state and not insure a person for the same reason in another state. I think WI laws probably suck as much as anyone's.

I had BCBS private insurance pre-PCOS dx. DH took a job with group coverage when I was PG with DS2 which we took. DH left that job while I was PG and we used COBRA insurance for about 6 months (available here for 18 months). Then I looked for new insurance since COBRA is outrageously expensive and I was informed the premium was going up $400 PER MONTH!!!

So, I looked for private insurance again. I was then uninsurable with BCBS because of PCOS (VERY clearly stated in their rejection letter), once I got a rejection from 1 insurance company, every company denied me for the same reason. So, I ended up with state insurance that is the equivalent of Medicaid, just I don't qualify for Medicaid. My doctors are all under the policy and the premium is reasonable, so really not a huge deal. Plus I have maternity coverage now which is NOT mandated in WI with private insurance companies. DH and the kids are with the NASTY BCBS since their premiums are wonderful and have great coverage--as much as it pi$$es me off to use them.

You can apply at most companies website, online and it takes a few days to a few weeks to hear from an underwriter about acceptance. I'd do that 1st before you give notice about leaving, just in case insurance and pre-existing conditions are a problem.

That's my bad-luck story!