by Kelly1959 » Mon May 21, 2012 06:57 pm
What is the time period between cancelled health insurance and new insurance that I don't have to get a physical? I'm in Arizona. I've heard 90 days and I've also been told by a broker 63 days. Which I'm suspicious of. Thank you.
Posted: Tue May 22, 2012 03:15 pm Post Subject:
Are we talking about having lost an employer-sponsored health plan or an individual plan?
If the answer is "individual" insurance, then both answers are wrong. If the answer is an "employer-sponsored" plan the broker's response is closer to correct, but still wrong. In the standard individual health insurance market, there is no guaranteed issue health insurance. However, almost no applicants are required to undergo a "physical" to obtain coverage -- underwriters make their decision about insurability from the application and possibly a Medical Information Bureau file. Prior medical records may also be reviewed.
Under COBRA, an employee/dependent who loses coverage under an employer-sponsored plan as a result of one of the six qualifying events must apply and begin paying the premium for continuing coverage under the group plan within 60 days of the qualifying event. Coverage remains continuous and there are no other qualifications than paying the premiums. It's the same insurance from the same company, at the same total cost . . . the only difference is that the individual now pays the full cost, which can be hundreds or thousands of dollars more than they paid in the past.
The number "63" applies to eligibility for a new employer's group health plan without a preexisting condition exclusion, under HIPAA, when new employment occurs within 63 days of being terminated from a prior employer-sponsored health plan and going to work for another employer that provides group health benefits. To avoid all preexisting exclusions under the new plan, the employee must have been covered under their former employer's plan at least as long as the preexisiting condition exclusion period in the new employer's policy (typically 6 months, but not more than 18 months from the date of hire under federal law). The employee must complete any "probationary period" required by the new policy, which also cannot be longer than 12 months from the date of hire under federal law for a full-time employee.
Posted: Tue May 22, 2012 03:59 pm Post Subject:
Thank you for your response. Yes you are right about the preexisting condition exclusions. I was confused, couldn't remember what I had been told. Never had to do all this before. So what I'm getting is that March 11th is too long ago to avoid the exclusions. Such as my high cholesterol. Which is unfortunate, but doable. I need to work on being healthier anyway :D Thank you again.
Posted: Tue May 22, 2012 07:29 pm Post Subject:
what I'm getting is that March 11th is too long ago to avoid the exclusions
This may or may not be true. What you may have missed is the time to apply for COBRA continuation coverage. But if your employer failed to notify you of your right to continue the group plan, you may still have time to do so.
In the individual health insurance market, if your only challenge is high cholesterol, that should not be an obstacle. If you are taking medication for the condition, it could result in a substandard rating, but not a decline or an exclusion. If you are taking a combination of medications for high blood pressure and high cholesterol, for example, that could increase the substandard rating, but, again, would be unlikely to result in an exclusion.
Certain combinations of prescription medications can currently result in a decline for health insurance for adults. This is set to go away by 1-1-2014 under the PPACA, unless (1) the US Supreme Court decision due in June completely overturns Obamacare, or (2) the Republicans take complete control of both houses of Congress and the White House in November -- both outcomes are possibilities.
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