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rzemanfl Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 06:31 PM
Original message
HIPAA question. I know that when a person goes from one job
with group health insurance to another there are no pre-existing condition exclusions on the new employer's group policy. Here is my question, I have covered my wife on my group health insurance for about 20 years. If she now gets a job with group insurance and I don't, will the same HIPAA provisions (i.e., no pre-existing condition exclusions) still apply or does the fact that she would be the primary insured make a difference?
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nashville_brook Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 06:36 PM
Response to Original message
1. my understanding: as long as it is "group" insurance -- thru a job, there's no pre-existing
i was in this situation and had the same concern. when i got my new job i found out that "group" (thru a job) insurance just doesn't do "pre-existing" restrictions.

anyone else have another experience?
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rzemanfl Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 06:40 PM
Response to Reply #1
2. That's what I am hoping. We can survive walking away from the
house in Florida, but not without insurance. I am too old to be job-hunting.
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napi21 Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 06:46 PM
Response to Original message
3. There's no pre-existing conditions considred when it's group ins.
It's only when you buy individual policies that the ins. co considers that.
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Ruby the Liberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 07:32 PM
Response to Reply #3
8. Sadly, not true in all states.
States regulate insurance, not the Feds and there are group policies that require individual applications and medical history.

That IS one of the benefits to the Fin Reg bill - it creates Fed oversight of insurance for the first time.
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WillowTree Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 07:57 PM
Response to Reply #8
16. Wrong-O. HIPAA is federal and applies to all group policies in all states.
No state insurance regulations trump HIPAA. Or the insurance provisions in ERISA or COBRA, for that matter.
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Ruby the Liberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 08:11 PM
Response to Reply #16
21. Thanks for the correction.
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napi21 Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 08:06 PM
Response to Reply #8
19. Sorry I did not know that. I have exp. with Pa, SC, TX, & Ga.
nd none of them have pre-existing considersations for group policies. At least the didn't as recent as 3 years ago.
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Ruby the Liberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 08:11 PM
Response to Reply #19
22. No, it was me that was wrong. See post #16 above.
Edited on Wed Jun-30-10 08:12 PM by Ruby the Liberal
Edit to correct post #
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mourningdove92 Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 07:19 PM
Response to Original message
4. If she has been continuously covered, then preexisting
would not apply. Group insurance CAN impose a pre-existing clause if a person has been uninsured then gets coverage.
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rzemanfl Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 07:31 PM
Response to Reply #4
7. Thank you. It is only because of BP that we are even considering
a huge change in our '60s. The plan was to stay here and spend our golden years at the beach....
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Ruby the Liberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 07:29 PM
Response to Original message
5. As long as she hasn't had a gap in coverage (check with your state on how long)
she is covered.

When your last policy ended, by law, they had to send you a letter showing the coverage from/to period. That is your ticket - if a new company tries to impose pre-existing conditions clauses, you need to show them that proof of coverage.

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rzemanfl Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 07:32 PM
Response to Reply #5
9. Nothing has happened yet. She has been on my current policy
for about 14 years.
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Ruby the Liberal Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 07:33 PM
Response to Reply #9
10. If you are current, you have nothing to worry about.
Sad to hear you are having to think about uprooting though. :(
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rzemanfl Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 07:45 PM
Response to Reply #10
13. We can continue to dream the mess in the Gulf can be cleaned
up. So far that hasn't worked too well though.
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SheilaT Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 07:30 PM
Response to Original message
6. I'm no expert, but when
I was for a while on HIPAA, then got a job with health insurance, it became VERY important to document my HIPAA coverage, so as to eliminate the possibility of pre-existing conditions.
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tammywammy Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 07:54 PM
Response to Reply #6
15. I think you mean COBRA not HIPAA. n/t
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WillowTree Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 07:42 PM
Response to Original message
11. OK, here's the skinny.
So long as you become eligible for coverage with the new employer within 63 days of the date when the coverage under the old employer terminated AND so long as the new employer has more than 20 employees, no pre-existing conditions provision under the new plan can be applied. It has nothing at all to do with any state law or state insurance requirements. It's federal.
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rzemanfl Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 07:44 PM
Response to Reply #11
12. The "you" part of that bothers me. It was always me. Now it
would be her.
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WillowTree Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 07:52 PM
Response to Reply #12
14. Doesn't matter.
As long as you meet the 63 days thing and the 20 employees thing, you're OK.

When you leave your current employer, they will have to give you a letter ("Certificate of Creditable Coverage") which will show that you've had family coverage since whenever and that your wife was covered on the same policy. She will need to give that to her new employer when she goes through orientation and that should be all that's necessary. There may or may not be a waiting period before the new coverage goes into effect (rarely more than 90) days after the date of hire, but if there is, so long as the waiting period begins within the 63 day window, you'll be OK.
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Statistical Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 08:22 PM
Response to Reply #12
26. The person of plan providing coverage is irrelivent.
She is either covered or not covered. The plan or provider of the coverage doesn't matter. She could be going from Medicaid it doesn't matter.

GAP of 63 days of less (or no GAP) then no problem.
GAP of 64 days+ then pre-existing coverage limit *may* (depending on plan) apply but only for first 12 months.
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underpants Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 07:57 PM
Response to Reply #11
17. Not disagreeing... but- a contract is a contract
if the OP changes the contract or TO ANOTHER CONTRACT then the new conditions are the conditions.

I would suggest staying with what the OP has unless it is remarkably cheaper or the pre-existing is not a factor.
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WillowTree Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 07:59 PM
Response to Reply #17
18. You have no idea what you're talking about in this case.
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underpants Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 08:07 PM
Response to Reply #18
20. I have every idea what I am talking about
thank you
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WillowTree Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 08:12 PM
Response to Reply #20
23. And you've been directly involved in the employee benefits design & admin business for how long?
Edited on Wed Jun-30-10 08:19 PM by WillowTree
In most states, group policies can still contain pre-existing conditions clauses, but so long as the conditions I outlined above are met, such pre-X clauses cannot and do not apply and that's federal law.

I don't get paid what I do to see to it that those regs are enforced for nothin'.
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underpants Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 08:22 PM
Response to Reply #23
27. You forgot about price
they can't exclude people from their coverage but they can make it cost prohibitive


I process huge insurance payments every month. Reviewing about 20% of claims (4,000 Excel lines per month) and fully understand both group and Med D plans to an nth degree.
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WillowTree Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Jul-01-10 06:30 AM
Response to Reply #27
29. Wow!
I didn't realize you actually use Excel!! That must be some high-level insurance work you're doing there. LMAO!!

Whatever.
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Statistical Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 08:17 PM
Response to Original message
24. The only thing that matter is "continual credible coverage".
As long as she was covered (by any plan anywhere) and then went to another plan with no gap (technically you can have up to 63 day gap) then she is fine.

If she (or you or anyone) has a gap of 64+ days (for any reason) then depending on the plan you can be subject to pre-existing limitation but only for 12 months.
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rzemanfl Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 08:22 PM
Response to Reply #24
25. And that would go for me too? n/t
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Statistical Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 08:41 PM
Response to Reply #25
28. Yup (and anyone else in the country).
For each individual person going from one coverage to another regardless of how or why or was the policy holder.

So if you have coverage, then gap of less than 64 days and then coverage for whatever reason you are good.
If not you *may* have a pre-existing limit for first 12 months.
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gleaner Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Jul-01-10 07:21 AM
Response to Original message
30. HIPAA is the law that governs ...
your privacy when you are receiving medical services. It governs who your information may be released to. You have to sign a form the first time you see a doctor and every time you go to the hospital.

COBRA is your right to pay a portion of the cost of the health insurance you had to continue receiving benefits from the health insurance plan that you had when you were employed. I believe your portion would be the portion which the employer used to pay. It lasts for a finite period of time and was designed to cover individuals while they looked for another job or other health insurance.

I don't believe the health insurance offered by most employers bar dependents for preexisting conditions. I think if your wife got a job with health benefits she could add you as her dependent without any questions. If you have any doubts call your State representative and ask them what the law is governing such situations. That is the way it works in California and in the Federal workplace, but I don't know if other states have different laws or not. Good luck and I hope it works out for you and your wife.
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Tailormyst Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Jul-01-10 07:27 AM
Response to Original message
31. That's cobra not Hipaa- HIPAA is a privacy law
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Statistical Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Jul-01-10 03:43 PM
Response to Reply #31
32. No HIPAA also included provisions on minimum standard for group insurance policies
Edited on Thu Jul-01-10 03:43 PM by Statistical
include (as it relates to OP) prohibiting pre-existing condition limitations if the person remained covered with a gap of less than 64 days.

Hence the Portability part of HIPPA (Health Insurance Portability and Accountability Act)
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