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        New Message Board Archives >> 2005 General Board Posts >> Insurance/Cobra ? ...DD/Blossom?
        
(Message started by: nani on Jun 7^th, 2005, 12:59am)

Title: Insurance/Cobra ? ...DD/Blossom?
Post by nani on Jun 7^th, 2005, 12:59am

My husband started a new job today. (Thanks to all who sent good vibes...they worked :) )
The new company has only 9 employees, so they carry an individual, not group, health plan. The plan (the same one that paid out over $50,000 for my brain surgery in 1999) rejected me (just me, not the hubby or kids). I have Cobra paperwork from his last job somewhere on my desk....can I apply for Cobra benefits for just myself? How long can I stay on it? I can get a job with the school system in the fall and get group coverage, but I'd rather stay part time. Any hope?

Title: Re: Insurance/Cobra ? ...DD/Blossom?
Post by Lizzie2 on Jun 7^th, 2005, 1:21am

Nani -

I don't really know enough about all this to be of much help, but I do have one question (or maybe a few questions) - did you have any break in insurance coverage or a period of time where you were uninsured? I thought that if you have no break in coverage, then the insurance company has to take you on (and also cover pre-existing conditions). Maybe this is just if you go from one group plan to another group plan and not group to individual? Just a random thought...

My mom works for a school district, and the way her insurance works - I could be covered under her plan until I graduated college or until I turned 23 - whichever came first. Unfortunately, I turned 23 in the middle of my last year at Penn State, so that's when we began the cobra at $350/month. I think I had 2 years that I could be on cobra once I turned 23? It was something like that...

Anyways...my thought would be that if you were fully covered under your hubby's insurance - shouldn't you have every right to cobra just like the primary insured? I really have no clue...but I'd be curious about this as well!

Hope that you get something figured out!!

Hugz,
Carrie :)

Title: Re: Insurance/Cobra ? ...DD/Blossom?
Post by pattik on Jun 7^th, 2005, 10:19am

Hi Nani,
Dealing with health insurance can be exasperating! I've done it. I was on a cobra plan which allowed me two years to find a new plan. But each plan is probably different. You should be covered on your cobra plan, but you probably need to contact the insurer to find out the details. Good luck with this, and I feel for you [smiley=hug.gif]. I'm really happy about your husband's new job.
Hugs....pat

Title: Re: Insurance/Cobra ? ...DD/Blossom?
Post by Donna_D. on Jun 7^th, 2005, 10:39am

Has it been more than 60 days since he left his last job?

Will the old carrier still allow you to sign up for COBRA?

If so...TAKE IT! The premiums will be high but worth it in the long run especially if you plan on starting work in a few months.

COBRA is usually approved for 18 to 36 months. Find out the answers to the above questions and while you have your husbands old carrier on the phone ask them how long you can continue paying for coverage.

You need to maintain your coverage no matter what. ESPECIALLY if you have already been rejected by another insurance carrier.

Call me if you need me, I am always here to help.

DD

Title: Re: Insurance/Cobra ? ...DD/Blossom?
Post by nani on Jun 7^th, 2005, 10:43am

It's only been 3 weeks since he left his last job. I figured I had some time. The Cobra premium would be $750/month for the family, so I'm hoping I can just pick it up for myself. It's BC/BS Texas...I'll call them today. Thanks everyone.... :)

You know...it's just not right when an overweight smoker with high blood pressure who's already had a brain hemorrhage can't get health ins... ;;D

Title: Re: Insurance/Cobra ? ...DD/Blossom?
Post by Donna_D. on Jun 7^th, 2005, 10:51am

Nani,

BC/BS of Texas is my old stompin' grounds....worked there 10 years.

If you need some help or some strings pulled...give me a holler!

DD

Title: Re: Insurance/Cobra ? ...DD/Blossom?
Post by nani on Jun 7^th, 2005, 10:53am

Thanks, Donna...hopefully I won't need any strings pulled, but it's nice to know I have a "connection". :)

Title: Re: Insurance/Cobra ? ...DD/Blossom?
Post by Lizzie2 on Jun 7^th, 2005, 1:17pm

Donna -

Do you know how that works about pre-existing conditions/getting denied for insurance? I'm curious especially for the future!

This probably was all told to me in reference to switching from group to group because my mom has group insurance, and even when I temporarily went to Aetna through Jefferson - it was group. After my 60th day of work (read that correctly - one way that the benefits office nails ya - NOT after 60 days...60 work days! blah), then I will qualify for group coverage at Jefferson. I have a choice of 4 plans, but I'm not making the same mistake I did last time...I'm doing what it takes to have the best plan they offer - which is the BS/BC Personal Choice.

So here's my question - I was told so long as there was no break in coverage, that I couldn't be denied insurance and they couldn't block my pre-existing conditions. Is this just true when switching from group to group? Say I had to look for private insurance on my own, but while I was still insured currently with a group plan. Can a private plan (through whatever company) still reject me and/or refuse to cover pre-existing conditions even though I've not had a break in coverage?

The only way Jefferson gets ya is through their own benefits option. I can't use short-term disability (and I don't even think I can use their long-term disability) for any pre-existing condition I had prior to starting full time employment at Jefferson. It's not even like I have to wait a year - I can't use it - ever. Doesn't that seem unnecessarily cruel? Thank God (I hope..) for FMLA, should I need to take time off for either headaches, AVN surgeries, etc.

Do they have a college major that allows you to learn every factoid possible about all insurance companies? LOL My mom once said (while on the phone with a representative from BC/BS) that every person should be forced to take a class on health care plans so that they at least know all the info before finding out the hard way. Then at least if they still deny something big or you run into a major snafu, at least you already knew it could happen instead of being caught by surprise! haha

Hugz,
Lil Sis :)

Title: Re: Insurance/Cobra ? ...DD/Blossom?
Post by Karla on Jun 7^th, 2005, 1:57pm

From my experience it is just the employee takes cobra or the whole family has to take it. It is only available for 18 months. Should be the exact same benefit plan that you had before. Good luck!

Title: Re: Insurance/Cobra ? ...DD/Blossom?
Post by Donna_D. on Jun 7^th, 2005, 2:54pm

on 06/07/05 at 13:17:41, Lizzie2 wrote:

Donna -

Do you know how that works about pre-existing conditions/getting denied for insurance? I'm curious especially for the future!

So here's my question - I was told so long as there was no break in coverage, that I couldn't be denied insurance and they couldn't block my pre-existing conditions. Is this just true when switching from group to group? Say I had to look for private insurance on my own, but while I was still insured currently with a group plan. Can a private plan (through whatever company) still reject me and/or refuse to cover pre-existing conditions even though I've not had a break in coverage?

A break in coverage is defined as a period of more than 60 days without coverage. If you adhere to that criteria they cannot exclude your pre-existing conditions (what is technically known as a rider on the policy) from coverage. This applies to coverage when switching from one group plan to another. NOT group to individual.

An Individual plan can choose not to cover you.

Quote:

Do they have a college major that allows you to learn every factoid possible about all insurance companies? LOL My mom once said (while on the phone with a representative from BC/BS) that every person should be forced to take a class on health care plans so that they at least know all the info before finding out the hard way. Then at least if they still deny something big or you run into a major snafu, at least you already knew it could happen instead of being caught by surprise! haha

Hugz,
Lil Sis :)

Yes. Unfortunately the only place you can take it is "The School of Hard Knocks"!

I'm a graduate!

DD

Title: Re: Insurance/Cobra ? ...DD/Blossom?
Post by Kris_in_SJ on Jun 7^th, 2005, 8:36pm

Hi Nani,

Sorry about the situation. I used to be an HR professional. That would be prior to becoming a non-profit executive, followed by self-employed (and paying EXTREME insurance premiums), etc., etc.

Either your husband continues his insurance under COBRA as it was (family) or coverage ends. Period. To my knowledge, you can't get it just for yourself. The insurance coverage has to remain the same as it was before termination.

Maybe it's different in your state, but COBRA laws are pretty much a Federal requirement.

If I had a wish right now, it would be that this wasn't true in your case. You might try getting your own policy through BCBS, though the premiums might still be pretty high.

Best of luck and Hugs,

Kris

Title: Re: Insurance/Cobra ? ...DD/Blossom?
Post by blossom on Jun 7^th, 2005, 11:17pm

Nani-

Sorry I'm late chiming in here... you can take out cobra just on yourself, however, you do only have a certain amount of time to decide. You would be better off to take out the COBRA than to try to get an individual policy. With an individual (also known as a Direct Pay) policy you have to disclose all your past health history or it can AND WILL be a pre-existing condition which can turn into an exclusion on the policy. With your health history you want to take the easiest route which would be the COBRA which is the exact policy that you had when your husband was employed with the previous company. There are several loopholes on the 18 month coverage - it's very easy to stay on for 36 months which most people do not know and insurance companies don't want you to know. Little glitch here - the size of the group matters on this - if it is below 20 people in the group they only have to offer you COBRA for 9 months and/or not offer it at all, but since they have already sent you the info - not a problem! The cost of the COBRA would most likely be about the same amount as a direct pay policy so you would probably be better off. Don't wait on signing up for it because it can take awhile to get all the paperwork done and you don't want to be stuck paying for a prescription or something when you don't have to. It's a pain in the butt to get reimbursed for it once you've paid out of pocket for it. If you have any specific questions - give me a holler and if I don't know or can't find the TX law then I will call down to BCBS of TX and find out for you. Easier for me to deal with them than you! I know the right questions to ask and understand the answers. Anything I can do to help, let me know. You have my e-mail addy if you need to use it. ;;D

Karen

Title: Re: Insurance/Cobra ? ...DD/Blossom?
Post by Lizzie2 on Jun 7^th, 2005, 11:55pm

If I learned one thing from my insurance nightmare last year, it was....better to pay more for a better policy than to pay less for a policy that won't cover what I need.

I thought I would save money by going to a student plan instead of paying the expensive cobra on my mom's plan. Uhhhh......

Yeah the plan was about $130 less per month...moved from PPO to HMO. In the end - I wound up having to sell every share of stock I owned and basically break my piggy bank because I was paying through the nose for what the HMO wouldn't cover.

I learned my lesson once....it's fine to go with a less expensive plan if you are a healthy young student who has never had a blood test in your life (i.e. - my former roommate from nursing school) - but if you're someone like me...it's worth it to pay. No worries - I was just temporarily insane when I made that decision. ;)