Health insurance question

[dullard]

My current work gave me an okay deal for Blue Cross / Blue Shield at $80/month for high deductable coverage. No problem since I'm in good health, I am fit, and I've only needed to see a doctor once in the last 10 years or so (thought I broke my foot but I didn't).

But, I recently took an opportunity to do a little side job and cut my main job back from full time to regular time (4 days a week). I was told that I could keep my benefits at the main job and that there would be no difference. Well it is time to redo the insurances for the year and now they want to charge me $160/month for the same thing. Why? I'm not a full time employee.

So, I go to the BCBS website and I can buy the same exact coverage for $80/month as an individual. Or, they have a new even higher deductable plan for $31/month. I plan to join my fiance's plan when we get married in 10 months (she works in the pharmaceutical industry and they get fantastic benefits). So, I'd save $1300 by switching for 10 months to the BCBS high deductible account.

However, I've heard horror stories about people switching from individual plans to work-sponsered plans with a pre-existing condition. Basically the new employer plan won't cover it but ttat they have to cover it if you go from one employer program to another. Is this true? Or is it a myth?

I don't have a pre-existing condition, but my brother has a cronic illness and it is possible that someday I may get it too. I have no signs or symptoms. But I do want to keep it in the back of my mind. I really only want insurance to cover these long term expensive cases. I just want to know what would happen if I do get a pre-existing condition in the next 10 months.

 

[nakedfrog]

Pre-existing conditions are conditions that were already diagnosed, so I don't think you have anything to worry about yet.
No idea, other than that, but I may find out in April (our traditional renewal/switching of carriers).

 

[dullard]

Originally posted by: nakedfrog
Pre-existing conditions are conditions that were already diagnosed, so I don't think you have anything to worry about yet.
No idea, other than that, but I may find out in April (our traditional renewal/switching of carriers).

I just want to know what would happen if I do get a pre-existing condition in the next 10 months. It is unlikely, but possible.

 

[Uppsala9496]

A pre-ex has to be diagnosed and you have to have been treated at a doctor for it.
I used to underwrite group health.

No worries if you haven't seen a doc about it in the last year.

 

[Uppsala9496]

Originally posted by: dullard

Originally posted by: nakedfrog
Pre-existing conditions are conditions that were already diagnosed, so I don't think you have anything to worry about yet.
No idea, other than that, but I may find out in April (our traditional renewal/switching of carriers).

I just want to know what would happen if I do get a pre-existing condition in the next 10 months. It is unlikely, but possible.

You can't get a pre-ex. Either you have something and have been diagnosed and treated for it, or you don't.
It really is black and white. And it is very easy to prove if they give you any shit.

 

[Viper GTS]

Isn't one of the major advantages of company sponsored insurance is they have enough buying power to negotiate coverage that does not exclude pre-existing conditions?

Also, wouldn't your employer insurance be pre-tax vs post-tax on your own (unless it exceeds the threshold at which you can itemize, & for a healthy person that is unlikely)? That would help cover some of the difference.

Viper GTS

 

[Ns1]

So in the same vein, my GF DOES have a preexisting condition. What happens if we get married and I want to insure her under my company's health plan?

 

[Uppsala9496]

Another thing to point out, is that if you have had continuous coverage, you won't run into a pre-ex issue.
It's when you have a gap in coverage that causes problems (which is why you buy cobra if you get term'd until you can get new coverage in place).

 

[GasX]

Typically, at least for employer based plans, pre-existing conditions are covered as long as there is no gap in coverage. The definition of "gap" is variable and can be anything from 1 day to 60 days without coverage.

For example, I was recently unemployed and insured under COBRA. My new job started on the 5th of the month and I did not feel like paying the premium for the whole month so I had a 4 day gap in coverage. I checked beforehand and the new carrier had a ~30 day gap requirement, so I was fine.

one other point, I was ready to pay that premium if we had any medical expenses during that 4 day period - thank god for grace periods.

 

[SacrosanctFiend]

Originally posted by: Viper GTS
Isn't one of the major advantages of company sponsored insurance is they have enough buying power to negotiate coverage that does not exclude pre-existing conditions?

Also, wouldn't your employer insurance be pre-tax vs post-tax on your own (unless it exceeds the threshold at which you can itemize, & for a healthy person that is unlikely)? That would help cover some of the difference.

Viper GTS

HIPPA protects preexisting conditions in group-to-group insurance switches. I'm not sure about individual-to-group insurance switches, but I remember something about a 12 month max period. I'll have to look it up...benefits isn't my strong suit.

 

[Uppsala9496]

I forget the exact section in HIPAA that accounts for the portability portion of the insurance that deals with pre-ex's.
If your GF has coverage in place, she won't have an issue moving to your plan when you get married. The pre-ex won't be considered a pre-ex if she had coverage before.

 

[dullard]

Originally posted by: Uppsala9496
You can't get a pre-ex. Either you have something and have been diagnosed and treated for it, or you don't. It really is black and white. And it is very easy to prove if they give you any shit.

Thanks for the responses. I may not be making myself clear. Suppose that next month I am develop and am diagnosed with cronic ATOTosis. Then when I get married, and switch insurances, is that a pre-existing condition that the new insurance won't cover? Or will it be covered since I've had continuous coverage just with multiple changes in the types of plans.

Originally posted by: Uppsala9496
Another thing to point out, is that if you have had continuous coverage, you won't run into a pre-ex issue. It's when you have a gap in coverage that causes problems (which is why you buy cobra if you get term'd until you can get new coverage in place).

I don't plan to ever have a gap. It'll be through BCBS for years even with multiple switches.

So, you don't think I'll have a problem? Is saving $1300 ($900 or so after tax) the best option?

 

[Ns1]

.

 

[Uppsala9496]

Ns1, that is a tricky one. I'd have to see the contract language in the plan and know the diagnosis. HIPAA really started to kick in when I first started medical underwriting. There were plenty of people on the plans I did with pre-ex's that had coverage.
Honestly I don't see them excluding all coverage for something that was diagnosed at someone so young.
And I am assuming that she has always been on some sort of medical plan? If that is the case, then absolutely no worries about her being covered and it not being considered a pre-ex.
My memory is fading as I get older, but I recall this being a really hot topic back in the mid to late 90's.

 

[Uppsala9496]

Originally posted by: dullard

Originally posted by: Uppsala9496
You can't get a pre-ex. Either you have something and have been diagnosed and treated for it, or you don't. It really is black and white. And it is very easy to prove if they give you any shit.

Thanks for the responses. I may not be making myself clear. Suppose that next month I am develop and am diagnosed with cronic ATOTosis. Then when I get married, and switch insurances, is that a pre-existing condition that the new insurance won't cover? Or will it be covered since I've had continuous coverage just with multiple changes in the types of plans.

Originally posted by: Uppsala9496
Another thing to point out, is that if you have had continuous coverage, you won't run into a pre-ex issue. It's when you have a gap in coverage that causes problems (which is why you buy cobra if you get term'd until you can get new coverage in place).

I don't plan to ever have a gap. It'll be through BCBS for years even with multiple switches.

So, you don't think I'll have a problem? Is saving $1300 ($900 or so after tax) the best option?

No, it is not a pre-existing that will not be covered. You were diagnosed with something and had coverage at the time. As long as you don't have a gap in coverage you are fine. HIPAA addresses this issue for you (federally mandated so no worries).

As for saving the money....that is your call. As long as the plan is solid and you aren't giving away a ton of coverage or jumping to insane deductibles/co-pays/drug plans, go for it.
Without seeing the plans I can't offer any advice on that.

 

[AreaCode7O7]

Originally posted by: dullard

Originally posted by: nakedfrog
Pre-existing conditions are conditions that were already diagnosed, so I don't think you have anything to worry about yet.
No idea, other than that, but I may find out in April (our traditional renewal/switching of carriers).

I just want to know what would happen if I do get a pre-existing condition in the next 10 months. It is unlikely, but possible.

Employer to employer, no problem. Employer to individual, you'll probably pay through the nose on premiums. I have a pre-existing condition and I went from an individual to employer plan a few years ago. I don't recall any fuss... I might have had a six month probationary period where my costs were capped, but I'm not 100% sure about that. Effectively I was covered. I do know that I will NEVER let my insurance coverage lapse for any reason. Premiums could be more than my house payments and I would still pay.

 

[dullard]

Originally posted by: Uppsala9496
As for saving the money....that is your call. As long as the plan is solid and you aren't giving away a ton of coverage or jumping to insane deductibles/co-pays/drug plans, go for it. Without seeing the plans I can't offer any advice on that.

Basically, these are my choices that I'm considering (all PPO through BCBS):
1) Employer coverage: $1500 deductible, 20% copay after that (max $2400 out of pocket), Rx discount card, no preventative, no office visits, nothing else. $160/month.
2) Individual coverage: $3000 deductible, 20% copay after that (max $6000 out of pocket), Rx coverage with 20% copay, max $100 preventative yearly, $25 copay office visits, nothing else. $73/month.
3) Individual coverage: $2000 deductible, 30% copay after that (max $7000 out of pocket), Rx discount card, no preventative, no office visits, nothing else. $32/month.

Honestly, I'm really tempted by #3. Yes, the maximum out of pocket is higher compared to #1, but the coverage is the same otherwise. I'd save nearly a grand in premiums after considering tax benefits. But I risk paying $4600 more out of pocket in the worst case scenario (although tax deductions would reduce that a bit). That is a gamble I'm willing to take.