Ow. Ow ow ow ow ow ow ow ow ow OW!

[cute fuzzy bunny]

Just got our Cobra bill.

For two 45 year old adults and a 2 year old child...$1330 a month.

Of course we need two months worth to bridge the gap between our old BCBS policy and our new health coverage to avoid pre-existing condition clauses from kicking in.

OW!

 

[73ss454]

Seems like a lot but some how I think you can afford it.
Your not going to have to trade in the Lexus are you?

 

[cute fuzzy bunny]

No but I had to jump start it for the wife this morning. Gabe got into it and left the headlights on.

Somehow I feel like a car thats that expensive should call you up and tell you the lights are on and its battery is getting weak. At least a little "help. me. ..."

The first quote we got was for single coverage for just her and it was four hundred something...seemed reasonable. I didnt think family coverage meant just multiplying the rate times the number of people

Seems like wasted money. We havent needed much other than a few hundred in prescription meds. The only result is to have the new insurer cover my wifes meds for the next year (the period of exclusion for preexisting conditions). Of course, the meds for a year are about a hundred bucks more than two months of Cobra.

[homer]stupid ruuuuules[/homer]

 

[mykidslovedogs]

Just got our Cobra bill.

For two 45 year old adults and a 2 year old child...$1330 a month.

Of course we need two months worth to bridge the gap between our old BCBS policy and our new health coverage to avoid pre-existing condition clauses from kicking in.

OW!

Short term major medical coverage is also considered a "bridge gapper" if you don't want to or need to elect Cobra.

Health insurance carriers consider short term major medical coverage as creditable coverage when it comes to bridging a gap, and the premiums are much much lower, because the coverage is temporary, and while you are on it, you will not have any coverage for existing conditions. Having short term major medical coverage during a gap will prevent you from have pre-existing condition waivers on your new coverage when that kicks in. You can purchase it by the month or just by how many days you need it. Usually, a minimum number of days, typically 35 is required. Here is a link if you are interested:

http://www.assuranthealth.com/corp/ah/HealthPlans/ShortTerm

 

[73ss454]

I guess your wife's new job doesn't have medical or is there a waiting period.

Sorry, I just saw that you have 2 month waiting period.

 

[kramer]

$1330 definitely sounds excessive. I just got my COBRA bill. I worked for a Fortune 500 company. For a single it is $350/month (for some reason I thought it would be $400). That includes dental coverage, eye check coverage including paying for lenses, and almost zero deductible full blown medical coverage here in the Bay Area (even all of my travel shots were "free").

I ended up getting my own high deductible coverage that is much, much cheaper. It kicks in May 15 at which point I will gladly opt out of COBRA and pay them nothing.

I assume you know that you have 59 days plus the first billing period (or something like that) grace period (opt in at about 59 days, wait until end of subsequent billing period before paying, if other insurance has kicked in you can supposedly pay zero COBRA assuming you never used their medical services after termination).

Kramer

 

[kramer]

I like MKLD's idea if it is doable for you.

Kramer

 

[cube_rat]

Just got our Cobra bill.

For two 45 year old adults and a 2 year old child...$1330 a month.

Of course we need two months worth to bridge the gap between our old BCBS policy and our new health coverage to avoid pre-existing condition clauses from kicking in.

OW!

Yikes!!! You need boob woman back to console you

 

[mykidslovedogs]

One more thought...

If your other coverage just ended, and if you are going from large group coverage to coverage under another large group, you are not considered as having a "gap" (for the purpose of pre-existing condition limitations)until you have "gapped" for more than 62 days.

With Cobra, you have the right to elect Cobra upto 60 days from when it is first offered, and even if a condition arises, you can go back and pay the Cobra premiums and have your coverage reinstated as if it never ended. So technically, if your new coverage goes into effect in 60 days, you can just take advantage of your Cobra grace period, wait on paying any premiums, and not have to worry about any pre-existing condition waivers when your new coverage kicks in.

 

[Rich_by_the_Bay]

If your other coverage just ended, and if you are going from large group coverage to coverage under another large group, you are not considered as having a "gap" (for the purpose of pre-existing condition limitations)until you have "gapped" for more than 62 days.

With Cobra, you have the right to elect Cobra upto 60 days from when it is first offered, and even if a condition arises, you can go back and pay the Cobra premiums and have your coverage reinstated as if it never ended. So technically, if your new coverage goes into effect in 60 days, you can just take advantage of your Cobra grace period, wait on paying any premiums, and not have to worry about any pre-existing condition waivers when your new coverage kicks in.

I was thinking the same thing. You mentioned that this is a short-term bridge situation, so count up the days and if it is below 60 I'd just sit tight. If an expensive situation arises on day 59, call, pay your COBRA premium for the past 2 months and you're covered. I've seen it done more than a few times.

Also, be sure your wife's coverage is effective on the day she starts her job. There are cases where it starts, for example, on the first of the month after commencing employment, etc. Just a heads up.

 

[Freein05]

My wife and I retired early and used COBRA for our insurance. We used her employer which had a large employee base. We will be under COBRA for 36 months. This is good for us as most COBRA insurance is only good for 12 or 18 months. But it is costing us almost $1,000 a month and increases about 8% a year. It is good coverage under the HMO we have. We could not get any other coverage because of preexisting conditions.

Just be careful about doing anything other than COBRA. Also make sure her new employer does not require a physical or something. Some employers are now excluding preexisting conditions from health insurance coverage to keep their health insurance costs down.

 

[mykidslovedogs]

My wife and I retired early and used COBRA for our insurance. We used her employer which had a large employee base. We will be under COBRA for 36 months. This is good for us as most COBRA insurance is only good for 12 or 18 months. But it is costing us almost $1,000 a month and increases about 8% a year. It is good coverage under the HMO we have. We could not get any other coverage because of preexisting conditions.

Just be careful about doing anything other than COBRA. Also make sure her new employer does not require a physical or something. Some employers are now excluding preexisting conditions from health insurance coverage to keep their health insurance costs down.

Please don't take offense to this correction, Free. It's really important that people understand that Federal Law prohibits group insurers from imposing pre-existing condition limitations unless there has been a gap in coverage prior to enrolling. ...And for large group to large group coverage, you can have a gap of up to 62 days without being considered as having a true "gap" in coverage. Employers are prohibited from imposing pre-existing condition limitations on group coverage "just to keep health insurance costs down". They simply can't "pre-ex" you unless you have had a true gap of more than 62 days between coverages, and even then, there's a limit as to how long, going forward that you can be "pre-exed". Any kind of insurance including Short Term, Individual, Cobra, can bridge the gap between coverages. It does not just have to be Cobra.

It is required that Cobra be offered for a minimum of 18 months....and this is something I have to refresh myself on, but I'm pretty sure you get up to 36 months if the reason for termination of prior coverage was due to death, divorce or disability.

 

[kramer]

It is required that Cobra be offered for a minimum of 18 months....and this is something I have to refresh myself on, but I'm pretty sure you get up to 36 months if the reason for termination of prior coverage was due to death, divorce or disability.

I believe that there is a state statute in California that effectively extends it to 36 months (Cal-COBRA) for almost anybody.

Freein05, what is your plan when COBRA expires?

Kramer

 

[Freein05]

I believe that there is a state statute in California that effectively extends it to 36 months (Cal-COBRA) for almost anybody.

Freein05, what is your plan when COBRA expires?

Kramer

My wife worked for a county in California that has group coverage that will go into effect after the 36 months. I will only be on that for a year than I will go on Medicare and my rates will drop finally.

 

[Freein05]

Please don't take offense to this correction, Free. It's really important that people understand that Federal Law prohibits group insurers from imposing pre-existing condition limitations unless there has been a gap in coverage prior to enrolling. ...And for large group to large group coverage, you can have a gap of up to 62 days without being considered as having a true "gap" in coverage. Employers are prohibited from imposing pre-existing condition limitations on group coverage "just to keep health insurance costs down". They simply can't "pre-ex" you unless you have had a true gap of more than 62 days between coverages, and even then, there's a limit as to how long, going forward that you can be "pre-exed". Any kind of insurance including Short Term, Individual, Cobra, can bridge the gap between coverages. It does not just have to be Cobra.

It is required that Cobra be offered for a minimum of 18 months....and this is something I have to refresh myself on, but I'm pretty sure you get up to 36 months if the reason for termination of prior coverage was due to death, divorce or disability.

I was thinking of a small employer with less than 20 employees that would not fall under COBRA. But under HIPPA which governs insurance portability there are exclusions for preexisting conditions.

This is an important one: "Under HIPAA, the only preexisting conditions that may be excluded under a preexisting condition exclusion are those for which medical advise, diagnosis, care or treatment was recommended or received within the 6-month period before your enrollment date. (Your enrollment date is your first day of coverage, or if there is a waiting period to get into the plan, the first day of the waiting period.)”

And this: “The maximum length of a preexisting condition exclusion period is 12 months after your enrollment date (18 months in the case of a late enrollee). A late enrollee is an individual who enrolls in a plan other than on the earliest date on which coverage can become effective under the terms of the plan and other than on a special enrollment date.”

The exclusion period can be reduced by what is called creditable coverage on the link below you will find an explanation of creditable coverage. A person needs to be an attorney to understand all this crap.

Link for HIPPA Q&A

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

 

[mykidslovedogs]

Free -

You are correct, but the pre-existing condition limitation can only be imposed if there is a gap in creditable coverage of more than 62 days, or if you are a late enrollee (without a qualifying event such as loss of other coverage, marriage or birth of a child) onto the group plan. Short term, individual or COBRA all count as "creditable coverage".

Similar rules exist for small groups, but they are dependent upon state regulation. For example in Colorado, you can only be "pre-exed" if you have had a gap in coverage of more than 90 days, and only for a maximum of 6 months going forward. Additionally, you can only have a pre-existing condition limitation for conditions that were diagnosed or treated or that you sought treatment for during the 6 months prior to enrollment. These rules will vary from state to state in the small group market.

In the large group market, the rules are governed by HIPAA.

Furthermore, if you are enrolling onto an HMO product vs. a PPO product, then you are not as likely to have a pre-existing condition limitation imposed upon you. This is because HMOs enforce open-enrollment periods that protect them from adverse selection, whereas PPOs will typically, (but not always), allow you to enroll onto the plan first of the month following date of request. In order to protect themselves from adverse selection, or waiting to enroll onto the group only when a condition arises, PPOs enforce pre-existing condition waiting periods.

Most of the time, HMOs will make you wait until open enrollment to come on (with the exception of an involuntary loss of other coverage, marriage or birth), so they have an inherent protection built in to protect themselves against adverse selection, and that is why they are less likely to impose pre-existing condition waiting periods.

 

[cute fuzzy bunny]

See, thats where i'm a little bit confused. I thought that most short term 'gap' policies excluded prescription meds, and thats our biggest item. My wifes asthma has her on about $200-300/mo in prescriptions.

I thought that the contiguous coverage had to be approximately equivalent coverage, in other words, to get coverage on prescription meds we'd have had to have insurance that covered precriptions without a gap longer than 62 days.

I guess i'm not sure whether the coverage starts or stops at midnight the day before or the day after. She stopped working on 3/28/07. Our coverage expired 4/1/07 (I actually got her prescription filled that day and it 'took'). Our new coverage starts on 6/1/07 (the first working day after the first full month of employment, which is this month).

Seems like 62 days if you include the 6/1 'day'.

We're going from a PPO (BCBS) to an HMO (Kaiser). The paperwork she got from her employer says they enforce the 62 day 'creditable coverage' gap, and if you dont have that, exclude for 12 months any condition for which you've been treated in the past six months.

 

[Rich_by_the_Bay]

See, thats where i'm a little bit confused. I thought that most short term 'gap' policies excluded prescription meds, and thats our biggest item. My wifes asthma has her on about $200-300/mo in prescriptions.

MKLD may have more, but the advantage of COBRA in your case is that the coverage is identical to the policy it supplants (and you may get a free ride if you don't pay premiums and don't need services which require retroactivation of the COBRA coverage). The big issue is when the meter ended on the PPO side, and when it starts on the Kaiser side.

One of my kids had a similar close call on the timing, and asked if she could start her training a day earlier than anticipated (that is, to come in under the deadline to avoid a lapse). Some employers cooperate.

 

[Freein05]

That is way I would have taken the COBRA. The $2,600 you spend on COBRA could save you a lot in the long run if they exclude coverage for 12 months and something major happens because of the preexisting condition.

Go to the link I give above because as I understand it the creditable coverage can reduce the preexisting waiting time period. As I read it if you had creditable coverage for 12 months your waiting period for a preexisting condition is reduced by 12 months. Please read it and talk to HR at the new employer to be safe.

Edited to add: If you go past the 62 or 63 day time period you can not use creditable coverage and I think preexisting waiting period goes out to 18 months. In the link I gave above it is the department of labor Q&A on HIPPA which covers health insurance portability.

 

[cute fuzzy bunny]

I wish I'd read the paperwork and gotten the details in advance. We didnt know exactly when the new coverage started until she ran into the 'benefits guy' in the hallway and he threw out the 6/1 start.

I'm sort of leaning towards paying for one month of the cobra coverage because it is identical, which takes us to the end of April under 'creditable coverage', and leaves us at 30, 31 or 32 days between...depending on how you slice it.

I'd love to pay $300-400 for a short term policy and have it count the same, but I'm not sure that it does.

Sooo...anyone want to hazard a guess as to whether 4/1 to 6/1 counts as 60, 61 or 62 days?

 

[mykidslovedogs]

See, thats where i'm a little bit confused. I thought that most short term 'gap' policies excluded prescription meds, and thats our biggest item. My wifes asthma has her on about $200-300/mo in prescriptions.

I don't think you would run into a problem with self-funding your Rx for the next two months and supplementing that with a short term policy. I have called Humana before, and they did tell me that the short term policies would count as creditable coverage for new enrollees coming off of a waiting period.

I'll have to check on EBIA and see if I can find any precedence on that question. I'll let you know what I find out.

I'm going to call one of my buddies at Humana right now, and I'll let you know what I find out.

 

[mykidslovedogs]

I'm on the phone with Claims at Humana right now....

 

[mykidslovedogs]

I'm on the phone with Claims at Humana right now....

OK - They said that all they are concerned about is the fact that you had a medical plan in force during your gap. They don't care whether or not the 'gap' plan had prescription drug coverage or even coverage for the pre-existing condition for that matter.

Now, that's just what Humana said. I'm not sure about other carriers. To save yourself $1300, it might be worth a phone call to your wife's previous HR dept to see what they say. Just ask them if they can tell you what will count as creditable coverage. I'd be surprised if they won't count a short term policy. The HR people can call Kaiser to get a definitive answer.

 

[Freein05]

The break in coverage is 62 days. As Kaiser is going strictly by the regulations go to the following link it is the government web state and should answer all your questions. Do not depend on a third party unless it is an attorney. You have too much at risk.

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

 

[kramer]

The COBRA clock does not start ticking until you get the notification paperwork. For my Fortune 500, a separate entity handled this. So the clock did not start ticking until around 10 days after my termination. I don't know if this might give you a little leeway.

Kramer