How does employee health insurance work?

[Trek]

If one gets a full time job that includes health benefits, can one still be denied the health insurance for having a pre-existing condition?

Also, how does it work if one has a family? Do you have to pay extra for the other family members or are they covered under the employed persons health coverage?

 

[W2R]

Usually there is some waiting time before any pre-existing conditions are covered.

You can choose coverage for just yourself, or for yourself + family for a higher monthly premium.

 

[Urchina]

The cost of premiums also depends on how much your employer picks up. For example, we pay nothing in premiums for a fantastic health insurance package through DH's work. It includes dental and vision as well as medical and disability.

When I worked for the county, it would have cost $400/mo in premiums for just DH and I, up to $800/mo if we had kids. So we never got health insurance through the county, just through DH's job.

 

[Martha]

If one gets a full time job that includes health benefits, can one still be denied the health insurance for having a pre-existing condition?

Also, how does it work if one has a family? Do you have to pay extra for the other family members or are they covered under the employed persons health coverage?

Are you talking about the United States? Here, under HIPAA, group health plans have to cover even those with pre-existing conditions. However, there may be a waiting period. Under HIPAA, an employer health insurance plan can deny coverage for a preexisting condition only if the employee or dependent is diagnosed, receives care or treatment, or has care or treatment recommended in the 6 months before the enrollment date. Pregnancy cannot be denied as a preexisting condition. There also are limitations on how or if it can be applied to children.

The length of time coverage can be denied for a preexisting condition under HIPAA is limited to no longer than 12 months (18 months if you are a late enrollee). This time can be reduced or eliminated if you were covered by previous health insurance (which qualifies under HIPAA as creditable coverage) and if there was not a break in coverage between the plans of 63 days or more.


As far as family coverage, it depends on the employer. It may or may not offer it, and are free to charge more.

See my signature for my CYA.

 

[Trek]

Thanks. I was just wondering as my wife and I were toying with the idea of spending a couple years in the States before the kid(s) are old enough to start school here.

The wife would like to see some different areas of the U.S. (she's only been to Florida where I used to live) and kind of get a sense of what daily life is like there. But the obstacle is how we could manage to have health insurance coverage for the family while we are there.

Here in Europe it's easy. In Estonia for example, if you have a job you're covered and if you're a child, free until 19. If you don't work (like me) you just buy into the national health program and are treated like everyone else. In Germany, where we are now for a year, you can also just buy into the national health care scheme, no problem. And if one family member is covered (ie. paying) the rest of the family is covered for free. Easy. None turn you away for pre-existing conditions.

So the only way I could figure we could swing it, is if my wife got a job, which she wouldn't mind as she's just finishing up her degree in International Business here in Germany and is eager to work (she'll learn ). Or worse case scenario, I could get a job instead for the time we're there. But then the pre-existing condition issue could still be a problem perhaps.

Probably won't work out, unless Obama gets some universal coverage program going that we could buy into. I figure a few vacations from time to time over the years will have to suit her, but doesn't hurt to ask.

 

[Bimmerbill]

One of the really nice things about a Federal civil service job is that there are NO preexisting conditions.

 

[Trek]

Wish it was possible to buy into Medicaid or something. Wouldn't that solve a lot of problems just letting people do that? I've been reading a lot about some health care provisions in this $900 billion stimulus package, but where is that universal health care priority we heard about in the election campaigns from Hillary and Obama?

 

[Bestwifeever]

Here's what I don't understand about pre-existing conditions--if they're not covered by a new insurer, shouldn't they then be covered by the insurance that was being paid for at the time they "pre-existed"? In an ideal world....

 

[Gotadimple]

If you can demonstrate prior coverage, there is no pre-existing wait time. The former employer will provide a certificate to show the new employer.

-- Rita

 

[Trek]

If you can demonstrate prior coverage, there is no pre-existing wait time. The former employer will provide a certificate to show the new employer.

-- Rita

I don't have a former employer, just covered under the national health care of another country.

 

[Gotadimple]

Trek:
I should have clarified, that this is what the HIPPA regulations require of US employers. So you were correct in your initial analysis.

-- Rita

 

[JOHNNIE36]

Every time I read something about "national health care" I could just cringe. Let me quote some lines from a letter to the editor in the Tampa Tribune Wednesday. This from a snowbird Canadian, He says " Yes, Canadians have universal health care, but it is not free. Canadians are the most highly taxed group of people within North America. Canadians pay anywhere from 8% to 20% combined federal and provincial taxes for goods and services. The Federal income tax rates are up to 51% and based on your annual income. Most taxes go to maintaining our universal health care system. Taxpayers of Ontario pay an additional $900 per year toward the cost of improving the system. Wait times (doesn't specify what)are like 12 to 16 weeks except for emergencies and 6 to 12 months for a specialist, longer for some specialist. Many Canadians now do not have a primary physician. Health care costs continue to spiral out of control, and there is no accountability within the system or governments."

Does this sound like something we here in the United States want to take on?

 

[Martha]

Canada's per capita health care costs are almost half of what they are in the US.

 

[ziggy29]

Does this sound like something we here in the United States want to take on?

Somehow, these discussions always morph into a should-we-or-shouldn't-we about universal health care (or "national health care" or "socialized medicine" or whatever you want to call it).

And to me the response is always the same: High-quality. Highly available. Affordable. Pick any two.

Expecting a universal-coverage system to be affordable, top quality AND unconstrained in supply is an economic fantasy. And I think any reforms that don't acknowledge that very basic intersection of economics and human nature could well make things worse.

If we want top quality and affordability, we may have to accept rationing and/or long waits for non-emergency procedures.

If we want affordability and quick access, we may have to accept less than highest quality.

If we want top quality and high availability, we may have to accept that it's going to cost a LOT.

 

[eridanus]

Somehow, these discussions always morph into a should-we-or-shouldn't-we about universal health care (or "national health care" or "socialized medicine" or whatever you want to call it).

And to me the response is always the same: High-quality. Highly available. Affordable. Pick any two.

This makes some sense but there's no question that the US pays a LOT more for health care yet receives less. Study after study have shown this.

"Americans spend considerably more money on health care services than any other industrialized nation, but the increased expenditure does not buy more care, according to a study by researchers at the Johns Hopkins Bloomberg School of Public Health."

There's also the problem that we ALREADY pay for universal health care, at least in the ER, which has to treat people (albeit sometimes slowly and incorrectly).

"A new U.S. report found that government programs pay about $43 billion each year in health care bills for uninsured Americans."


McKinsey Report:
"Our research indicates that the United States spends $650 billion more on health care than might be expected given the country’s wealth and the experience of comparable members of the Organisation for Economic Co-operation and Development (OECD). [...] It’s not clear whether the United States gets $650 billion worth of extra value."

An article about this report:
Robert J. Samuelson - Obama's Health-Care Headache - washingtonpost.com

"For the extra money, we receive no indisputably large benefit in national well-being. On some health measures (breast cancer survival rates), we do better than many countries; on some others (life expectancy), we do worse. We are constantly searching for villains to explain this unsatisfactory situation. The McKinsey study debunks some popular candidates."

More,
"There is no major constituency for controlling spending. Because most patients don't pay medical bills directly, they have little interest in using less care or shopping for lower-priced services. Providers (doctors, hospitals, drug companies) have no interest in limiting care. What others call "health costs" are their incomes -- wages, salaries, profits."


"It's the prices, stupid."

It's The Prices, Stupid: Why The United States Is So Different From Other Countries -- Anderson et al. 22 (3): 89 -- Health Affairs

 

[Lister]

Usually any pre-existing condition is ignored during an employer's open enrollment period, which is typically on an annual basis. They do not even ask if there are any pre-existing conditions. My youngest daughter had Leukemia when I was offered a job with a new employer which happened to coincide with their open enrollment and this was a big factor in determining if I would accept the job. Her condition was not an issue, I took the job, and thank God 20 years later my daughter has been married for a year and just bought her first house! More grandkids next...

 

[Rich_by_the_Bay]

Here's what I don't understand about pre-existing conditions--if they're not covered by a new insurer, shouldn't they then be covered by the insurance that was being paid for at the time they "pre-existed"? In an ideal world....

Yes.

But that's just one of thousands of catch-22's in our current mess. I could write books about experiences my smart and conscientious patients have found themselves in because of logical and moral gaps in the current "system." The example of health insurance's effects on potential early retirement in another thread is just one example. Being dropped from insurance because you got sick and lost your job due to illness is another -- they exclude pre-existing, but won't take responsibility to cover you for "post-existing" carry-over of an illness which occurred on their watch. That's a quick way to go from affluence to bankruptcy.

But these issues are all known to the powers that be.

 

[martyb]

If one gets a full time job that includes health benefits, can one still be denied the health insurance for having a pre-existing condition?

Also, how does it work if one has a family? Do you have to pay extra for the other family members or are they covered under the employed persons health coverage?

U.S. government federal employees receive their choice of health benefit plans, with the employer paying somewhere between 72%-75% of the cost. The remainder is paid by the employee pre-tax. There are no pre-existing conditions. You could have a serious illness before you became an employee, and once you come on board, it's covered. Normal co-pays (mines $15 for an office visit) and deductibles (mine's $250 yr.) apply.

I'll be able to carry my insurance into retirement in 3 yrs 11 mo., and my share of the premium will stay the same, percentage-wise.

Oh yeah, yes, it does cost more for a family vs. a single person. My family is covered. 2 of my 3 kids are now too old for coverage on my plan. They were covered until thier 22nd birthday. I still have an 18 yr old on my policy, along with my wife.

Some parts of working for the govt. suck, but having relatively good health insurance coverage for life is something I truly am grateful for.

 

[Khan]

U.S. government federal employees receive their choice of health benefit plans, with the employer paying somewhere between 72%-75% of the cost. The remainder is paid by the employee pre-tax. There are no pre-existing conditions. You could have a serious illness before you became an employee, and once you come on board, it's covered. Normal co-pays (mines $15 for an office visit) and deductibles (mine's $250 yr.) apply.

I'll be able to carry my insurance into retirement in 3 yrs 11 mo., and my share of the premium will stay the same, percentage-wise.

Oh yeah, yes, it does cost more for a family vs. a single person. My family is covered. 2 of my 3 kids are now too old for coverage on my plan. They were covered until thier 22nd birthday. I still have an 18 yr old on my policy, along with my wife.

Some parts of working for the govt. suck, but having relatively good health insurance coverage for life is something I truly am grateful for.

I am a retired fed, and I sometimes feel embarrassed by how good my health insurance is.