Insurance Question: Job change and pre-existing medical condition

[EvrClrx311]

DW and I are 30 and we have two daughters. The youngest is 11 months old and was born with a congenital heart defect, a really serious one. She has spent 115 days in the hospital and undergone half a dozen major operations in the first year of her life. I'd estimate our insurance has spent above the $1,000,000 mark to date on her coverage... luckily we have REALLY good insurance and our out of pocket expenses and co-pays have been in the neighborhood of only $2,500 so far. There is no lifetime cap on our coverage.

Our daughter has gotten through the toughest part and has been at home for 3 months straight with just bi-weekly check-ups. Had her first word last weekend ("Mama" ) and is catching up quickly on all of the gross motor skills she fell behind on while sitting in a hospital bed for 3 straight months. She has one more open heart surgery to go at the age of 3, and should be out of the woods (crossing our fingers) and like any other child from that point on - other than the scars on her chest.

I have been getting job offers, really good ones, from other companies and although I like where I'm at now... I think at some point I'm going to need to move jobs to advance in my career. I've been with my current company since college, and I think I've gotten about as high as I can go here.

I know that back in 2010 a law was passed preventing insurance companies from denying coverage to children with pre-existing health conditions:

Quote:

One of the hallmarks of the Patient Protection and Affordable Care Act signed into law in March 2010 is the elimination of pre-existing condition requirements imposed by health plans. Effective September 2010, children (below age 19) with pre-existing conditions may not be denied access to their parents' health plan and insurance companies will no longer be allowed to insure a child, but exclude treatments for that child's pre-existing condition

...but I also know that not all health insurance is the same. I also know that companies aren't going to go out of their way to check on these things for you, they will lead you to believe that they've got you covered just to get you to sign on the dotted line and start working for them.

I think the smart thing is to stay put where I am now at least until our daughter gets past this next surgery, but I wanted to probe the audience here to make sure I'm not missing anything. My family and daughter(s) are the most important thing in my life so I would never do anything to jeopardize their safety/security. If it takes staying with the same company, I'll gladly stay.

Has anyone else gone through anything similar and can you give some advice/tips. What kinds of questions do I need to ask these companies, or more specifically their insurance companies if I start to entertain other job offers. Am I playing with fire even considering a career move? How do the new Obama laws effect things? Is this act that was passed in 2010 rock solid... and is my interpretation that another company would have to cover my daughter correct?

Finding a company with equal quality of insurance coverage is another question entirely.

I know this topic might not fit entirely with this board as it is about jobs and insurance instead of FIRE, but I thought I'd ask because you guys probably all have extremely valuable advice after spending a career working and dealing with insurance and job changes.



Anyone who is interested in a montage of my daughters story... please feel free to search "Isla's Story" on youtube and you'll find a video titled "What it Means To Be Loved - Isla's Story" as the top link (posted it here a few months ago... so some may have seen it already).

[MichaelB]

Sorry to hear about your daughter's health issues.

Health insurance coverage does not lend itself to generalities, so it is difficult to give advice. You are a real life example of the importance and benefit of good coverage. A prospective employer might think twice about hiring someone who focuses a lot on health care during the interview process.

Full implementation of the PPACA may be helpful to you by giving you access to options through the health care exchanges, so you can find a policy that gives the coverage you need. An employer that offers multiple levels of national coverage with one of the big insurers , such as BCBS or UHC might aas well.

Staying put is a good option. A year from now we should have a better view of the insurance options we all will have. The same applies to employers, and the link between job and health care may begin to fade.

[Brat]

If recruiters are knocking at your door tell them about your health insurance concern. The good ones will discuss this with the HR Representative who can contact their Benefits Administrator and let you know if their health insurance policy has coverage similar to your current policy.

Go forward with interviews, the people who you will be seeing won't know their health insurance details. Once an offer is extended ask to speak to their Benefits Administrator. I don't know if this is still the practice but some companies have additional insurance for 'key employees'.

[EvrClrx311]

Quote:

Originally Posted by MichaelB A prospective employer might think twice about hiring someone who focuses a lot on health care during the interview process

Thanks, this is definitely true and the reason I'm trying to educate myself on the current laws and policies. That way I can minimize the number of questions I need to ask during an interview and may deal more directly with the insurance companies once I find a position that looks like a good fit for me.

Quote:

Originally Posted by Brat There is no harm responding to feelers, even going through the interview process. When an offer is extended then you can discuss the details of their health insurance. Most benefits administrators in med-large companies can address your concerns in a nano-second and in my experience are empathetic.

Are they legally obligated to not lie. Should I be asking for stuff in writing? I can't help but feel that in some cases when dealing with a recruiter, man in the middle, they are just telling you want you want to hear to get you in the door. I get verbal responses to my questions a day or two later like "yes I checked, and you and your family will be fully covered after a 6 month waiting period, but your insurance at your other company should usually cover much of that."

[2017ish]

wow, makes me count our blessings.

Take a look at the provisions of HIPAA; you may well be able to structure a move to avoid any preexisting condition bar. I am rusty on this law, but it seems that if your daughter can go without the checkups for 6 months you can get coverage under a new employer's plan. Here is a link to DOL site discussing the law. Frequently Asked Questions about Portability of Health Coverage and HIPAA (Also note that some employers and states may not bar preexisting conditions in any event--as MichaelB observes, the area is full of ambiguities.)

Nonetheless, in your situation, unless you are comfortable with interpreting the regulatory language, I'd consider paying/retaining someone knowledgeable to look at things and give you advice before starting to job hunt. Better safe than sorry.

[Brat]

Outside Recruiters are all liars. They want to 'make the match' or they don't get paid. On the other hand they don't want to get the reputation of wasting their client's time.

Frankly I wouldn't accept a job where the health insurance policy had a 6-month waiting period, period. That is typical of a small employer whose policy is less likely to have the features you need.

I would limit the universe of potential employers to med-large employers.

[JOHNNIE36]

If it were me, I would stay put until your daughter is finished with all the surgeries. I think you mentioned three years down the road and her surgeries would be over as far as you knon. I had 34 years experience with a major company and found out over the years that you just can't believe what someone tells you. You might have misunderstood. What ever is promised I would get in writing. Even then you might find out in the company documents that "we have the right to ammend, revise or eliminate this coverage at any time" covers them in whatever they want to change in the future. I don't care if you go to work for the Pope, get it in writing.

[MichaelB]

No exclusion of pre-existing conditions is required by law as long as there has been continuous coverage - not interrupted for more than 63 days. As long as you are within the window, pre-existing conditions coverage in a new policy should not be a concern. I would think your bigger issue is the policy itself. "We have coverage for that" doesn't mean all that much. Most insurance companies have hundreds of different policies with much different levels and types of coverage and network, so just because "they have xxx insurance" doesn't mean you have access to the network you require or the specific procedures you will be needing.

I don't see anything wrong with entertaining offers from recruiters as long as you are upfront with them. What you want to avoid is getting a reputation of stringing along the interview process and then walking away after they have invested time. This could come back to haunt you down the road.

You can begin to familiarize yourself with your state regulations at KFF here.

[mystang52]

I'm glad to see that apparently your daughter is on the road to recovery.
As to job hunting and insurance concerns - there is no reason to ask about insurance to a prospective employer and certainly not a headhunter.
If you interview for a job, and the company makes you an offer, that is the appropriate time to ask about benefits....including health insurance.
I see no reason you cannot start a job search now. If an offer is made, you can always turn it down if the benefits package is not to your liking.

[Mulligan]

You are correct to be concerned as your daughters health and safety and your financial resources could be at risk. I have come to believe unfortunately that no one knows how to do their job. My mortgage refinance has been screwed up, home owners policy from agent was screwed up, and escrow "professionals" have all not done their job even thought they said they did, I had to correct them, as I learned you cant trust anyone to do their job right. Concerning health insurance, when I retired over two years ago, I was told by the HR paperwork director, that my insurance was good through that August. I went in for a physical that August to take advantage of the better insurance. Well about 2 months later, I got a bill from doctor, saying bill was declined because insurance was expired. Thanks to trusting people in the know I went insurance naked for a month and didn't even know it. Don't take anyone's word, see it on paper in contract!

[KB]

If I were you, I would PM DGolden (on this site) who I believe is an insurance broker and ask his opinion.

I worked in health insurance for many years and at that time, group insurance accepted all employees into the group and any dependants. It was only individual insurance that had restrictions based on pre-existing conditions, etc. The thing to watch for group insurance was whether there was a waiting period or not. Whether that still is the case, I'm not sure.

[pb4uski]

I would proceed with entertaining job offers and part of that process would be to look at the prospective employer's health insurance programs and how pre-existing conditions are treated. I think for most employers as long as you have coverage when you switch that you will continue to have coverage, but the coverage, deductibles, etc may be different. If you get an offer, then you can have the HR confirm to you in writing how your daughter will be covered if there is any question.

Glad to hear your daughter is on the road to recovery.