Getting individual insurance in ER with history of cancer

[vic]

Hubby and I are 37 y/o. I am as healthy as it gets. Howver, hubby had cancer in his 20's. I already left megacorp. He is unexpectedly leaving too, so we will be on our own for health insurance very soon. I peddle around in my sole proprietor stuff for all our tax write offs. I just asked my TX insurance agent to give me some individual/group quotes. She is working on it now, this is her preliminary response what I should take:

".....The individual plans cover maternity. If maternity is not an issue then
you would want to go with the small group. The benefit is that it is an
automatic issue whereas the other you would both have to qualify
individually....."

Maternity is out of the question for me, so it would be better if I don't even have to pay for that. I like the automatic approval. We will be HIPAA eligible anyway I think. I will let you know what type of stuff she comes up with.

Vicky

Vicky

[tnedator]

Originally Posted by vic

Hubby and I are 37 y/o. I am as healthy as it gets. Howver, hubby had cancer in his 20's. I already left megacorp. He is unexpectedly leaving too, so we will be on our own for health insurance very soon. I peddle around in my sole proprietor stuff for all our tax write offs. I just asked my TX insurance agent to give me some individual/group quotes. She is working on it now, this is her preliminary response what I should take:

".....The individual plans cover maternity. If maternity is not an issue then
you would want to go with the small group. The benefit is that it is an
automatic issue whereas the other you would both have to qualify
individually....."

Maternity is out of the question for me, so it would be better if I don't even have to pay for that. I like the automatic approval. We will be HIPAA eligible anyway I think. I will let you know what type of stuff she comes up with.

Vicky

Vicky

What does "you would want to go with the small group" mean in this context? Would that be a group of two, you and your husband, working for your sole proprietor company, or joining some other kind of group? Since whenever my wife retires, she will be HIPPA eligible, staying in a group would be ideal, based on what I know at this point.

[vic]

Small employer plans are at least 2 employees I believe and that would be a group plan. Yes, it would be me (the sole proprietor) and I will create some BS position for hubby. Going from one group to another group health plan will give you the greatest protection with HIPAA from what I understand.

Vicky

[tnedator]

Originally Posted by vic

Small employer plans are at least 2 employees I believe and that would be a group plan. Yes, it would be me (the sole proprietor) and I will create some BS position for hubby. Going from one group to another group health plan will give you the greatest protection with HIPAA from what I understand.

Vicky

That could certainly be an option for us when we finally do retire. When that time comes (not sure how soon it will be), I/we will likely want to do something anyway, and having some part time business could keep us occupied.

[mykidslovedogs]

Some states allow you to have a "business group of one" if you have been in business for at least a year. Colorado is one of those states. Although "group of one" insurance is guaranteed issue, you are limited to only four plan designs if you have any pre-existing condtions. Those four plan designs are the Standard or Basic PPO and the Standard or Basic HMO plans. Open enrollment dates include the date when you involuntarily lose other coverage, the date when your COBRA has been exhausted and the time frame within 30 days of your birthday. The open enrollment periods protect the insurance carriers a little bit from adverse selection by making it only possible to enroll when certain qualifying events exist.

If you have a group of 2 or more, you can have access to any group healthplans, anytime. However, the catch is that your second employee must pay income taxes, and you must show that as employer, you are paying unemployment insurance taxes on your employee in order for that person to qualify as an eligible employee. Secondly, that person must work a minimum of 24 hours/week to qualify as an employee, and he or she MUST show enough income on the quarterly wage and tax report as proof that they are making at least minimum wage on a 24-hour work week in order to qualify as an employee. You can't just make up some BS position and qualify as a group of two. There will be underwriting requirements to prove employment. Proof of payroll or proof of quartery unemployment insurance taxes will be required before coverage will be offered.

Granted, the various states have differing underwriting guidelines, but my guess is that you won't be able to just create some BS job title and automatically have a group of 2. You will have to be paying some kind of employment taxes, FICA, FUTA and SUTA on your employee(s) in order to prove employment.

[Tommy]

Originally Posted by mykidslovedogs

Some states allow you to have a "business group of one" if you have been in business for at least a year.

Would the premium for one person in a group of 1 be about the same as a Hippa rate?

[vic]

Originally Posted by mykidslovedogs

Granted, the various states have differing underwriting guidelines, but my guess is that you won't be able to just create some BS job title and automatically have a group of 2. You will have to be paying some kind of employment taxes, FICA, FUTA and SUTA on your employee(s) in order to prove employment.

I don't have to pay all of those taxes because I am related to my husband. Besides, all those income taxes are a wash since they end up on the same return - so it does not make much of a difference at the end. It is no problem to pay him 24 hours at minimum wage for yes - a BS job - title. I don't see any reason why I can not be flexible in creating a job for him since he will be leaving his current place of employment. I will be meeting with the agent to go over all of it. I have not heard of 24 hour/week but we can also arrange for that as needed. I guess every state has its own particulars.

Vicky

[mykidslovedogs]

Originally Posted by vic

I don't have to pay all of those taxes because I am related to my husband. Besides, all those income taxes are a wash since they end up on the same return - so it does not make much of a difference at the end. It is no problem to pay him 24 hours at minimum wage for yes - a BS job - title. I don't see any reason why I can not be flexible in creating a job for him since he will be leaving his current place of employment. I will be meeting with the agent to go over all of it. I have not heard of 24 hour/week but we can also arrange for that as needed. I guess every state has its own particulars.

Vicky

Well, the "catch" is that employers have to "match" the social security taxes that the "employer" pays out of his income taxes. So, even though you are related and all "income" pays the same taxes, as an employer, you will have to pay the employer's share of the social security taxes on your "employee", and that will be on top of what you are used to paying. I think it's about 7% of income....Once people realize this, they usually decide not to do the "group of two". At least, that has been my experience....unless you have no other choice.

Secondly, in order to prove employment in the State of Colorado, you have to show at least one quarter of unemployment insurance tax payments (and they can ask for two) or...sometimes, if you can show a minimum of 8 weeks of payroll, they will sometimes let you get by with that as well. ...Don't know how it will be in Texas, but I imagine the insurance underwriters will want to see some kind of proof of employment.

Also, my guess is that you are going to have "sticker shock" when you see the group insurance rates. I am surprised that in Texas, individual insurance comes with maternity, while group insurance does not. In Colorado, it's the other way around..In fact, I'm certain that it is a Federal Mandate that all group insurance plans, small or large, must include maternity coverage, so I think you might be misinformed on that (...although it is possible that some carriers may allow you to opt out of the maternity coverage, but I don't think it will make that much difference in savings in the group market)......And small group insurance tends to be much more expensive than individual insurance, mostly because it is guaranteed issue, so adverse selection (buying the insurance AFTER it is needed) takes it's toll on the rates. This is because the general "pool" of members in the small group market tend to be "unhealthier" than the pool of members in the "individual" insurance markets.

Regardless, I wish you luck and hope it all works out for you.