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Heinz H | Can health insurance coverage be denied (because of a prexisting condition) after COBRA expires? |
I retired from my job at 65. After my retirement my company "kicked out" our two dependent children from the company health plan. Both children are at this time still covered under COBRA.
Concern: Our son has a preexisting condition (Crohn's). When COBRA expires can he be denied coverage by the 'next' insurance company?
Note, HIPPA gives only 63 days during which insurers cannot deny coverage when you change. The 63 days period has "expired".
Additional Details
sorry for the typo : HIPAA |
 |
 
Rick
 |
HOLD ON EVERYONE!!!!!!!!!
First - Yes the insurance companies can deny coverage when applying through their STANDARD individual plans.
HOWEVER - once you have fulfilled your COBRA obligation (normally 18 months) you are entitled to a HIPAA Policy. Every state has these and every indivdual carrier offers them. They ususally come in two forms; those being "Standard" and "Basic".
They are not cheap, and as long as you do not have a gap in coverage - from when COBRA expires - of more than 63 days you are entitled to purchase a HIPAA Qualified Health Plan (see below link page 4).
Also, your dependent children are entitled to continue their COBRA coverage for 36 months - not 18 - see the below link (page 12 & 16):
http://www.dol.gov/ebsa/pdf/cobraemployee.pdf |
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sarah314
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The 63 day period has absolutely nothing to do with the question you're asking.
You are asking if an insurer can refuse to issue a policy to your son because he has a medical condition. The answer is yes...whether your COBRA expired yesterday or 3 months ago. If your son applies for a policy that has to go through medical underwriting, then he can be rejected and not offered coverage at all.
The 63 days have nothing to do with whether or not you're OFFERED coverage...it just stipulates how your claims will be handled IF you get another policy.
Medical conditions are assigned "points" when determining whether the insurance company will allow the person to sign up for a policy. The policy has a maximum limit to the number of "points" an applicant can have and still be allowed to obtain a policy. One very serious medical condition could be worth enough "points" to get a person turned down for insurance, or the person could have several minor conditions added together where the "points" put them over the limit.
(The 63 day period for pre-existing conditions refers to the denial of CLAIMS after a policy is issued. Completely different issue, as you're asking whether your son would be allowed to get a policy at all.
A person can have a minor pre-existing condition that doesn't keep them from getting a policy...however, if they have a break in coverage for longer than 63 days, their claims for that specific condition only can be denied. For example, you have high blood pressure but are still allowed to get a policy. You had a break in coverage longer than 63 days. If you have a claim specifically relating to high blood pressure during your waiting period, then that specific service would be rejected. However, if you break your arm falling out of a tree...something totally unrelated to your blood pressure...the claim for that service would still be covered.)
Your son's best bet for coverage would be to get insurance through his own employer...that way, he is part of a group and doesn't have to go through medical underwriting as an individual. Crohn's can be an expensive condition to manage, and it could very well make him ineligible to obtain his own private policy. (Or at the very least, send his premiums through the roof.) |
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Christie
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Yes, an insurer could deny coverage for pre-existing conditions. However, your 63 day period won't start until the last day of COBRA coverage. When COBRA ends, you just have to make sure to secure other medical coverage within 63 days to avoid an issue with pre-existing medical conditions. So, if you have a plan in place to take effect when the COBRA coverage expires, there won't be a gap in coverage and therefore, under HIPAA regulations, pre-existing will not apply. |
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mbrcatz
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Yes. Private insurance companies are allowed to underwrite you, and there isn't any "guaranteed issue" on health insurance.
Typically, the HIIPA only applies when you are moving from ONE group plan, to ANOTHER group plan - NOT for individual plans. |
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hightechchic
 |
Yes, unfortunately, that's why the 63-day limit exists. Beyond that limit, insurance companies can refuse to issue policies for anyone based on pre-existing conditions and even if they approve the applicants, they can also deny coverage for pre-existing conditions for 12-24 months (or even put an exclusion rider on for the length of the policy, depending on applicable state laws and issuing guidelines.)
Unfortunately, you missed the window. I have to deliver this kind of news on a regular basis, unfortunately. You really should read those documents they send to you after you leave a company. There are some VERY important details about things like that!
Edited to add:
Wait -- you said that they are STILL covered? IF they are still covered under COBRA, then you will have up to 63 days to obtain coverage WHEN COBRA RUNS OUTS. Start early, though. He may still get better rates going through underwriting (and they still can't decline him coverage for pre-existing conditions.) I recommend you apply at least 30 days before COBRA runs out in order to try to get a final rate in time to make sure you've got your best option (and you may want to apply with more than one company so you can compare rates.)
You had 63 days to decide to take COBRA or not when you left the job. You have 63 days at the end of COBRA to get another plan.
Incidentally, it may be cheaper to get them both individual policies regardless. You may want to check into that option before the COBRA option runs out.
Good luck! |
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