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Should I give up group HI and apply for individual policy?
Old 10-08-2012, 08:32 PM   #1
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Should I give up group HI and apply for individual policy?

My employer recently decided to stop offering my particular group health insurance plan which I've been on for several years. Instead, employees are being offered a different set of group plans which are significantly more expensive. Since my current plan is an HMO, I will not be able to continue seeing any of my current doctors if I change to a new plan.

So, I'm considering applying for an individual policy with my current HMO instead of going with the new employer group plan. I'm about 40YO, no major health issues in the last 5 years. However, about 6 years ago I had major surgery for a condition which needs to be monitored with lab tests and MRIs annually. Not sure if this would cause my application to be rejected, given that most of the questions on the app ask about treatments within the past 5 years only.

Pros of getting an individual policy:
  1. No longer dependent on work to provide HI, especially if I want to ER in a few years.
  2. Can continue to see my current doctors who are familiar with my medical history.
Cons:
  1. I would no longer be HIPAA eligible, in case I develop a serious pre-existing condition and need to apply for HI again sometime in the future (for instance, moving across state lines where I need to change HI providers again).
  2. Still costs more than the group plan, but is currently affordable.
Also, not sure exactly how Obamacare will impact these choices in a year or two.

Any thoughts and comments on this welcome.
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Old 10-08-2012, 10:24 PM   #2
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Do you have an actual personalized quote? I can't believe a yearly MRI wouldn't boost the cost too high. Other than the cost, it doesn't seem any worse than what you would do in ER anyway. With no worry about transitioning HI into ER.
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Old 10-08-2012, 11:55 PM   #3
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Do you have an actual personalized quote? I can't believe a yearly MRI wouldn't boost the cost too high. Other than the cost, it doesn't seem any worse than what you would do in ER anyway. With no worry about transitioning HI into ER.
Not yet, but none of the questions on the application required me to disclose the annual MRIs. They ask things like "Have you been treated or diagnosed" for certain conditions within the past 5 years. Maybe someone more knowledgeable in the insurance field can correct me, but I don't think annual tests and diagnostic MRIs qualify as "treatment."
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Old 10-09-2012, 02:30 AM   #4
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You are kind of stuck until the guaranteed issue part of the so called "Obamacare" starts in 2014 ?, IIRC. California prohibits individual exclusions for conditions in most situations, so the carriers usually just decline to write the policy. The verbage is usually something like" Treated for, sought treatment for, advised to seek treatment for,etc. Just about anything medical , procedure or test is "Treatment ".

It doesn't hurt to apply, other than your time.

Most carriers were asking about last 10 years of medical history last time I applied , trying to get individ. coverage (2005).
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Old 10-09-2012, 08:01 AM   #5
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Not to be a downer, but a realist. The application is the easy part, wait until the underwriter starts asking for medical records from each procedure and visit for the last 10 years.
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Old 10-09-2012, 08:18 AM   #6
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Figner, you should speak with an insurance agent to find out if you are eligible for either a conversion or an individual plan. The conversion plan can be a safer option because it is still subject to some group plan protections, but because your employer is not canceling HI, just changing policies, it is not clear you are eligible.

For individual coverage HI companies can look as far back as they want, no limits, and also can deny coverage for any reason, which they do. The conversion policy is guaranteed issue, although they do have pricing flexibility and can cancel under some circumstances.

Most of your coworkers must be unhappy as well if the new plan does not cover the same doctors. Is the employer aware of this?
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Old 10-09-2012, 09:36 AM   #7
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As was mentioned the application is usually just the first step. You can expect a phone call before approval where they will ask a lot more detailed questions to fill in any gaps. It certainly can't hurt anything to go through the process and find out.
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Old 10-09-2012, 10:13 AM   #8
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Originally Posted by Animorph View Post
I can't believe a yearly MRI wouldn't boost the cost too high.
That used to be the case, but it is changing like other technologies that have decreased in price over time.
MRI Cost and Pricing Information

Why an MRI costs $1,080 in America and $280 in France - The Washington Post
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Old 10-09-2012, 04:18 PM   #9
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If it were me, I think I would stay with the employer's plan until the elections are over and we have a better idea on how Obamacare will operate (assuming that it continues to exist in some form).
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Old 10-09-2012, 08:01 PM   #10
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Based on some of your responses, maybe I'm being too optimistic about being able to get the individual coverage. I did speak to an insurance broker about applying to this HMO, and was advised that they usually reject outright (instead of offering coverage with exclusions), but that I might as well try and fill out the application. I'm still waffling, and will let you guys know if I do manage to get the coverage.
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Old 10-09-2012, 08:06 PM   #11
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Figner, you should speak with an insurance agent to find out if you are eligible for either a conversion or an individual plan. The conversion plan can be a safer option because it is still subject to some group plan protections, but because your employer is not canceling HI, just changing policies, it is not clear you are eligible.
The only conversion policy I've heard of is via the HIPAA rules. If that's what you're referring to, I'm not eligible according to the application: it says to get a HIPAA policy, you must not be eligible for any kind of group HI.

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Most of your coworkers must be unhappy as well if the new plan does not cover the same doctors. Is the employer aware of this?
Yes, plenty of unhappy coworkers here! Many have been complaining on the employer's online discussion boards, but it hasn't resulted in changes so far.
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