Re: Happy Holidays & a question about insurance.

December 26, 2011

Between the time your son was " no longer a student " and last fall, the law

changed from a parent's insurance only covering full-time students to covering

anyone up to age 26. That's for typical children.

Start by asking Aetna to provide to you a certificate of group creditable

coverage for your son, which will give his name and show when his coverage began

and when the coverage ended.

When you get that, hang on to it and keep it among important paperwork. If you

have to get other coverage elsewhere, they'll want a copy of it as evidence of

coverage.

At this point, you know that Aetna stopped covering him in June, and that you

did not know this until August, which is probably goes beyond the 63 days

without coverage. So a new plan does not have to factor in Aetna's coverage,

and may try to exclude pre-existing conditions for up to 12 months.

But I submit that Aetna's " tough luck if you don't read your mail " answer won't

fly. Call your state rep and tell your story--coverage ended even though your

son is in his late 20's, which meant that Aetna knew he was disabled and was

covering him as an disabled dependent adult child, unless you just got on this

insurance plan, you didn't know how to fight this because to the best of your

knowledge, you never got paperwork telling you his plan ended, and that you

found out in a phone call to Aetna months later.

Ask state rep what can be done. This is not a case of a person who lost

insurance. This is a case of an disabled dependent adult child who should not

have been dropped from your insurance because of his age, and the insurance is

saying " You should have told us, we aren't going to change this because it's too

late now. "

There's also some state agency in IL that you can contact for complaints about

insurance (including appeals), but if the rep's office thinks that's a good

route, they'll tell you and have that info handy.

IIRC, Aetna has a reputation for being squirrelly.

-Gail

________________________________

From: Liz <dljar58@...>

IPADDUnite

Sent: Sunday, December 25, 2011 8:18 PM

Subject: Happy Holidays & a question about insurance.

Hoping everyone enjoyed their holiday. We had a quiet relaxed day at home. The

end of the year is bringing new challenges for us.

Does anybody know of a good health insurance co. that will cover a 29 yr old

disabled adult who's not a student?; (individual coverage)

Found out in Aug or Sept. that my son was terminated from my group insurance

policy, due to his age. He was terminated on June 1st. Supposedly Aetna had sent

a letter to us, but it was never received.

I sent back a form, but was told that the eligibility forms were not submitted

timely. (am also being told that they didn't receive the forms. (The letter

says otherwise.) (he was already over 26 when our company changed insurance

co's. & he's been covered all this time....I'm still also paying the premiums

for him;which I'll be getting back if our appeal is denied.

He does have Medicaid & will have Medicare in 1 1/2 yrs, but possibly needing

something short term.

Liz

December 26, 2011

Liz your best way to go is turn the over to a layer that special in this area

Their is a lawyer in this group he can help you or direct you to someone

Sent from my BlackBerry® smartphone with Nextel Direct Connect

Happy Holidays & a question about insurance.

Hoping everyone enjoyed their holiday. We had a quiet relaxed day at home. The

end of the year is bringing new challenges for us.

Does anybody know of a good health insurance co. that will cover a 29 yr old

disabled adult who's not a student?; (individual coverage)

Found out in Aug or Sept. that my son was terminated from my group insurance

policy, due to his age. He was terminated on June 1st. Supposedly Aetna had sent

a letter to us, but it was never received.

I sent back a form, but was told that the eligibility forms were not submitted

timely. (am also being told that they didn't receive the forms. (The letter

says otherwise.) (he was already over 26 when our company changed insurance

co's. & he's been covered all this time....I'm still also paying the premiums

for him;which I'll be getting back if our appeal is denied.

He does have Medicaid & will have Medicare in 1 1/2 yrs, but possibly needing

something short term.

Liz

December 26, 2011

Don't forget Illinois Statute (since 1969), 215 ILCS 5/367b, which allows our

children to stay on Employer Group Health Insurance Policies, regardless of age.

That statute provides as follows:

(a) This Section applies to the hospital and medical expense provisions of a

group accident or health insurance policy.

( If a policy provides that coverage of a dependent of an employee or other

member of the covered group terminates upon attainment of the limiting age for

dependent persons specified in the policy, the attainment of such limiting age

does not operate to terminate the hospital and medical coverage of a person who,

because of a handicapped condition that occurred before attainment of the

limiting age, is incapable of self-sustaining employment and is dependent on his

or her parents or other care providers for lifetime care and supervision.

defined as requiring a Community Integrated Living Arrangement, group home,

supervised apartment, or other residential services licensed or certified by the

Department of Human Services (as successor to the Department of Mental Health

and Developmental Disabilities), the Department of Public Health, or the

Department of Public Aid.

(d) The insurer may inquire of the person insured 2 months prior to attainment

by a dependent of the limiting age set forth in the policy, or at any reasonable

time thereafter, whether such dependent is in fact a disabled and dependent

person and, in the absence of proof submitted within 31 days of such inquiry

that such dependent is a disabled and dependent person may terminate coverage of

such person at or after attainment of the limiting age. In the absence of such

inquiry, coverage of any disabled and dependent person shall continue through

the term of such policy or any extension or renewal.

(e) This amendatory Act of 1969 is applicable to policies issued or renewed more

than 60 days after the effective date of this amendatory Act of 1969.

(Source: P.A. 88-309; 89-507, eff. 7-1-97.)

_____________________________________________________

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From: IPADDUnite [mailto:IPADDUnite ] On Behalf

Of G Mrozak

Sent: Monday, December 26, 2011 11:10 AM

IPADDUnite

Subject: Re: Happy Holidays & a question about insurance.