- Thread starter
- #11
BobJam
New Member
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@ Cowbell,
Your situation, cost wise anyway, sounds more severe than mine.
Your situation, cost wise anyway, sounds more severe than mine.
Denial of Coverage Problem
- Thread starter BobJam
- Start date
I'm a little late to be jumping into this thread, but I just read it for the first time. I'm in AZ, and I've done group and Individual/Family health insurance here for 31 years.
The advice you've received so far on this forum is sound. But one issue has not yet been addressed. The e-health agent has led you to believe that you would qualify for a "catastrophic" plan from Blue Cross Blue Shield of AZ if/when your wife loses coverage "not of her own fault". This is NOT correct. Let me explain her rights, in AZ, if/when she loses coverage.
COBRA First, there's COBRA continuation of coverage if your employer employed 20 or more full-time employee equivalents in the preceeding calendar year. Yes, you're right, the cost is just as high as your current premium (except for the fact that you would no longer be covered under your employer's plan, so the premium would be for just your wife). Of all your options, this would be the most secure, and the highest benefit program.
HIPAA PORTABILITYIf your wife is not eligible for COBRA, or if she has exhausted her COBRA rights, she would most likely be eligible for HIPAA portability. There are some other qualification rules, such as the rule that she had 18 months or more of continuous health insurance without a lapse of 63 days or more, and the rule that her most recent insurance must have been GROUP insurance (including COBRA). The premiums for HIPAA portability are outrageous. However, this is your second most secure and beneficial option.
CONVERSIONMost insurance companies offer a conversion right, and most of those conversion rights are TRASH. If you take a conversion right and refuse COBRA, you cannot go back (after the COBRA window of opportunity to elect has expired). You would not qualify for HIPAA portability either, because conversion is individual/family coverage rather than group.
CATASTROPHIC Your e-health agent is wrong. There is no catastrophic plan you can get on an individual basis in AZ when the applicant has alzheimers. There are some minimeds and discount plans, but that's hardly sound coverage. He's wrong, and it angers me that he led you to believe you could/should cancel your group policy, refuse the other options, and leap to this conclusion. Don't just believe me. Call another reputable agent in AZ and ask. Call Blue Cross Blue Shield of AZ directly and ask. Better yet, go down to Blue Cross at the I-17 and Northern, walk into the front office and take a seat at one of the customer desks, and a Blue Cross employee will come consult with you personally. Please confirm for yourself that that agent gave you dangerous advice before you cancel your coverage or refuse your other rights.
These other rights are expensive. But remember that you will be on Medicare and a supplement, which is not as expensive as you have been accustomed to paying. Therefore the expensive premium will be for just your wife only. That should help with the budget a little.
The advice you've received so far on this forum is sound. But one issue has not yet been addressed. The e-health agent has led you to believe that you would qualify for a "catastrophic" plan from Blue Cross Blue Shield of AZ if/when your wife loses coverage "not of her own fault". This is NOT correct. Let me explain her rights, in AZ, if/when she loses coverage.
COBRA First, there's COBRA continuation of coverage if your employer employed 20 or more full-time employee equivalents in the preceeding calendar year. Yes, you're right, the cost is just as high as your current premium (except for the fact that you would no longer be covered under your employer's plan, so the premium would be for just your wife). Of all your options, this would be the most secure, and the highest benefit program.
HIPAA PORTABILITYIf your wife is not eligible for COBRA, or if she has exhausted her COBRA rights, she would most likely be eligible for HIPAA portability. There are some other qualification rules, such as the rule that she had 18 months or more of continuous health insurance without a lapse of 63 days or more, and the rule that her most recent insurance must have been GROUP insurance (including COBRA). The premiums for HIPAA portability are outrageous. However, this is your second most secure and beneficial option.
CONVERSIONMost insurance companies offer a conversion right, and most of those conversion rights are TRASH. If you take a conversion right and refuse COBRA, you cannot go back (after the COBRA window of opportunity to elect has expired). You would not qualify for HIPAA portability either, because conversion is individual/family coverage rather than group.
CATASTROPHIC Your e-health agent is wrong. There is no catastrophic plan you can get on an individual basis in AZ when the applicant has alzheimers. There are some minimeds and discount plans, but that's hardly sound coverage. He's wrong, and it angers me that he led you to believe you could/should cancel your group policy, refuse the other options, and leap to this conclusion. Don't just believe me. Call another reputable agent in AZ and ask. Call Blue Cross Blue Shield of AZ directly and ask. Better yet, go down to Blue Cross at the I-17 and Northern, walk into the front office and take a seat at one of the customer desks, and a Blue Cross employee will come consult with you personally. Please confirm for yourself that that agent gave you dangerous advice before you cancel your coverage or refuse your other rights.
These other rights are expensive. But remember that you will be on Medicare and a supplement, which is not as expensive as you have been accustomed to paying. Therefore the expensive premium will be for just your wife only. That should help with the budget a little.
