Something Else I Didn't Know

[AlmostDone]

I asked my DH to find out what COBRA would cost us with his company (an international relief organization). The response - they don't participate in COBRA. They do allow employees to purchase their health insurance for 18 months after termination, and it would be $200 a month cheaper there than with my company (a famous university). My question is, would we still be covered under HIPPA if we take the 18 months with his company?

[Rich_by_the_Bay]

Sounds like your company offers a "conversion policy" which may make you ineligible for COBRA immediately upon separation. It may be that you can access COBRA when that conversion policy is no longer available.

Oh, Martha?

[Martha]

When they say they will allow employees to purchase insurance for 18 months that sounds like it is COBRA. What they are saying doesn't make a lot of sense otherwise. It could also be offered under a state law similar to COBRA.

How big is the employer? What state are you in? Is the employer a church related organization, university or the federal government? If so, they may be exempt from COBRA.

You want to be sure that it is COBRA and not an individual conversion plan you would be buying because once you are out of the group market you lose your HIPAA rights.

Here are the HIPAA rules:

No matter where you live in the U.S., if you are federally eligible you are guaranteed the right to buy individual coverage of some kind with no pre-existing condition exclusion periods. To be federally eligible, you must meet all of the following:

´ You must have had 18 months of continuous creditable coverage, at least the last day of which was under a group health plan.

´ You also must have used up any COBRA or state continuation coverage for which you were eligible.

´ You must not be eligible for Medicare, Medicaid, or a group health plan.

´ You must not have health insurance. (Note, however, if you know your group coverage is about to end, you can apply for coverage for which you will be federally eligible.)

´ You must apply for health insurance for which you are federally eligible within 63 days of losing your prior coverage.

Federal eligibility ends when you enroll in an individual plan, because the last day of your continuous health coverage must have been in a group plan. You can become federally eligible again by maintaining continuous coverage and rejoining a group health plan.

[AlmostDone]

Martha,

It is a Church related international relief organization with about 4,000 employees world-wide. We are in Maryland. They said they are exempt from COBRA. So, we would not qualify under HIPPA? It's looking more and more like we will have to find individual policies. I am going to apply tomorrow to see what our cost would be.

We could take the COBRA from my employer for $845 a month. How could I find out what we would pay under HIPPA after that? It's all pretty confusing.

[Martha]

Ok, if they are church related, they may be right and be exempt from COBRA. I would want to know more about the 18 months of insurance they are offering you. Is it part of their group plan? Is it under a state continuation coverage requirement?

You have rights under HIPAA provided that you do not move to an individual plan. You need to use up any COBRA benefits (which it looks like you won't have) or state contination benefits, but then you have rights under HIPAA. HIPAA isn't an insurance plan, it is just a law that forces states to make sure that people who are otherwise uninsurable have an insurance policy they can buy when they are no longer eligible for insurance under their employer's group plan. HIPAA doesn't regulate cost so the policies available can be very expensive. You are better off buying on the individual market if your health is good.

I suggest working with a good insurance agent that understands these rights and get more info from your wife's employer. The insurance agent can help you with the application process for individual insurance as well.

[AlmostDone]

This is what his HR person said when he asked if he would be eligible under HIPPA:

"It means you can apply to an insurance company for an individual policy
and show evidence that you have exhausted the 18 months continuation
coverage under our company. This might avail you of coverage that will not
exclude pre-existing conditions. Aetna Global would send you a hipaa
certificate indicating the dates of your coverage."

So, it sounds like the 18 months would be under his group plan. My understanding of what HIPPA guarantees is this: Before the 18 months are up, we can apply for an individual policy. The insurance company will still ask about pre-existing conditions. They must offer us a policy without excluding any pre-existing conditions, but they can charge a higher premium. Is that correct?

The only way to actually find out what our premium would be is to apply. We each have one mild pre-existing condition, so we can't tell just from looking at the quotes on the internet. I haven't been able to find an insurance broker. I called the ones on the link that MyKidsLoveDogs provided, but they told me to contact the insurance companies directly. So, I started that process today.

[Martha]

So it looks like your employer is allowing you to buy continuation converage under their group plan, even though they are not subject to COBRA. I am surprised that you can't find a broker in your area. No independant insurance agents around?


To see specifically how individual insurance works and what your rights are in your state, including how it complies with HIPAA, go to www.healthinsuranceinfo.net.


Briefly, it looks like in Maryland insurance companies can turn you down or charge you more for individual health insurance based on your health condition. Maryland appears to implement HIPAA through a risk pool system so if you can't buy individual insurance, you will be able to buy into the risk pool. I have no idea how expensive it is. I does look like the lifetime caps on the Maryland pool are two million, which is pretty good.

[AlmostDone]

Thankyou so much, Martha. This is all very helpful. I'll be spending a lot of time on insurance in the next few weeks to really understand what our options are.

[Martha]

You're welcome. Let us know what you find out.