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coming off a group plan

G

Guest

Guest
Trying to sharpen my individual health knowledge a bit...

If someone is coming off of a group plan they have 63 days to apply for new coverage and as long as they get through underwriting the insurer must cover pre-existing conditions--right?

Thank you.
 
Not true across the board. In MO, if they answer the HIPAA questions & they have had no break in coverage for more than 63 days, they can have pre-ex covered, but with Blue Cross you agree to an across the board surcharge of at least 10% - that's over & above whatever the final rate comes back as. In some cases, that makes it very high.

I rarely have anyone insist on a HIPAA application due to cost. Not sure what the rules are in other states. In KS, the HIPAA questions aren't answered at all by residents of KS and the option isn't offered.

Not sure how it works in other places. most of the time, it's not cost effective & people just have to live with a 12 month exclusion.

Petrowski probably knows much more than I do on the specifics around this.
 
Here's the scoop; let's say someone just lost their job:

1) If they apply for an individual plan they are fully underwritten. Pre-ex conditions can be ridered, rated or they can be declined. However, some carriers like Aetna do give credit for having prior credible coverage which means if there's no break of 63 days in coverage then the 12 month waiting period doesn't apply. However, they can still rate up or decline. For companies like Assurant, GR and other companies that rider - they can still rider pre-ex conditions.

2) If they cannot get covered - say they're diabetic - as long as they're HIPAA eligible they can get a non-underwritten plan if Cobra isn't made available to them. Small groups don't have to offer Cobra.
 
The answer varies by state.

Once the group coverage ends they have COBRA options. Companies with fewer than 20 employees will have anywhere from 3 months to 18+ depending on small group laws in your state.

Once COBRA expires many plans have conversion options. In addition to conversion, some states (36 I believe is the correct number) have risk pools while others have an assignment system. Some states also have open enrollment.

Basically you need to find out how your state addresses the issue, then look at each carrier differently. As John indicated, Aetna will consider prior creditable coverage in setting the pre-ex waiting period.
 
I think the short direct answer is no. Say someone's just coming off group coverage and they have asthma. If they applied immediately to GR or Assurant both of those companies could rider the condition and provide no coverage for it.
 
I have a family of four that lost their group coverage Dec 31 and are being offered to continue under COBRA for $1000/mo.
They called me for individual, which I can do with BCBS for about $500/mo. (Their new zero deductible IPA)
The only pre-x is a medicated HBP. I guess I need to check with BCBS to see how they will treat this applicant.

Thanks for the good explanations.
 
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