Re: General Insurance Question - please help if you are...

September 28, 2004

You definately should ask these questions because just because it is the same

insurance company does not mean your employer and your husbands employer

purchased the same type of plans or coverage. For example, some plans have

preexisting condition clauses while others do not. Some plans completely exclude

speech therapy as developmental. or will only cover for stroke victims who spoke

before and stopped. The coverage you get can also be subject to state laws

where you live or where your employer purchased the coverage.

Hope that helps

(Mom to 6 yo girl with apraxia, cp and otherwise undiagnosed

developmental delays.)

September 29, 2004

Medica undoubtedly has more than one plan so you should read your husband's

plan booklet (may also be called a certificate) to determine what is covered

and look carefully at the exclusions also. If in doubt, your husband could

speak to whomever is in charge of insurance/hmo coverage/self insured plan where

he works.

Under HIPAA, my understanding is that you should have no more than a 62 day

gap in coverage or pre-x will be excluded for 12 to 18 months? You (and kids)

also wouldn't want to be a late entrant on your husband's plan or pre-x might

be excluded (I think for 18 monts)--enroll when you are first eligible. Have

your husband check how long you have to enroll after you lose coverage on your

other plan and then comply with any deadlines. You may need to get a

certificate of creditable coverage from your old plan (however, if it the same

company it may or may not be necessary).

The most important thing you can do is check the plan language and confirm

what is covered. If you are told it is not covered, ask what plan provisions

apply (in case you have arguments that coverage exists) and try to get it in

writing.

Also, depending on why you are losing coverage, you may be eligible get

continuation coverage from your old plan under COBRA or your state's

continuation

law; however, you would have to pay for it.

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