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Job change & Pre-exisiting condition (aka colon cancer)

menright's picture
menright
Posts: 258
Joined: Oct 2008

I am discussing a new career opportunity that could prove exciting. I am uncertain though that if I make a change and cancer were to return, I would not be covered under any new insurance company plan.

Anyone out there have any experience with this issue?

Mike

Sundanceh's picture
Sundanceh
Posts: 4408
Joined: Jun 2009

It's my understanding that a company cannot deny you insurance even with a pre-existing condition. I believe it's against the law.

You're NED now, so you just have to get past your probationary period with a new company (they can drop you any time during that period). Once you're past that, you've got FMLA.

If you lost your job due to performance, you could always sign up with your wife's insurance plan (Change of Life status), if she works.

Opportunities rarely knock twice, Mike...you're NED now and things look good for you, it's worth the risk to try something else.

Congrats!

-Craig

nudgie's picture
nudgie
Posts: 1483
Joined: Sep 2006

with Craig.

When DX (2006) I had NCPPO health insurance which covered everything without question. In 2008 I lost my job and found a new one in 2009. I currently have Cigna and have had CT and bloodwork and a colonscopy without any questions.

Good luck and I hope this new opportunity provides you happiness.

menright's picture
menright
Posts: 258
Joined: Oct 2008

If I chose to make a change, I would leave my current employer provided insurance with Aetna and sign on with the new company insurance program.

My concern is that I may get insurance and all will appear fine and then I have a cancer recurrence and the new insurance company proclaims "pre-existing" and I am stuck with thousands of dollars of bills. I have consumed up to $300K so far in coverage and a job change would quickly prove to be a losing proposition.

I will continue my research. Your story is encouraging. Thanks,

Mike

PhillieG's picture
PhillieG
Posts: 4906
Joined: May 2005

I do not think they can dump you if you have an occurrence. As messed up as our current system is I don't think they can do that.
Research on...If I read more I'll post it.
-p

lcarper2
Posts: 638
Joined: Dec 2009

I had Aetna and as soon as my cancer surgery was done they didn't renew me so be careful I don't like them they are sneeky

lisa42's picture
lisa42
Posts: 3661
Joined: Jul 2008

Hi,

I'm sure there would be a way to find out the actual insurance laws regarding this in your state. Enter your state, then Health Insurance Laws Pre existing conditions. I haven't recently checked, but check it out and see what you can find out. The huge aspect here is whether you would be paying privately for your health insurance, or whether you would be getting through an employer. In other words, if you go pursue a new career, then don't like it and decide to return to what you're currently doing for work, would you be returning to being self employed and/or to needing to pay on your own for your own insurance plan, or would you be returning to another employer, whom you could get insurance through? I believe you normally have problems when insurance coverage has lapsed from one carrier, then when you try to seek out a new plan with a new ins. company on your own, they can either deny you or, if they do accept you, they'll charge an outrageous amount. HMO's while limiting in aspects, do not normally have any exclusions or waiting time period before providing coverage. This is if you would be then getting it under a new employer. If you were just then on your own, calling insurance companies and getting quotes, I would predict you'd have a very difficult or expensive time getting health coverage at that point. Even through employer covered health insurance, PPO's can be more discrimanatory in their pre-existing conditions requirements with new people just joining the policy, although I do not know the actual laws about this- just what I've heard over the years. My husband used to work in the claims dept in the insurance industry, but hasn't been involved in that for several years now.

Currently, I am getting health insurance for my family through my former employer on COBRA status. (because it's better coverage, yet about the same cost to us as what my husband's small company offers- they only cover $100 per employee towards a family plan that costs close to $1500/month. I currently am paying $1491/month for my company's plan, but it's better coverage than the plan my husband's work offers. It's an HMO, but it's actually been really good about coverage. I did not pay one cent for my liver resection surgery and just have $10 copays for doctor's visits. Labwork is at no cost and CT and PET scans cost me only a $10 copay. All chemos and medications have been covered with no copay. You'll discover all companies have different policies and coverages though.). Normally, COBRA continued insurance coverage is allowed for up to 18 months after the date you left your job under the national COBRA laws (google it). After the 18 month period, an additional 18 months (for a total of up to 36 months) is allowed under the state program (at least it is in California- not sure if the additional 18 months is the case in all states). I used to pay my former employer monthly for my insurance costs until the 18 months expired. I am now 5 months into the CalCobra program under the state program and I now pay directly to the insurance company. Two months into it, my former employer changes insurance companies and forgot to inform me. That was a nightmare for a couple of weeks, as it happened right at Christmas/New Year's and everyone was out of the office for the holidays. Anyhow, I was still able to go with the new ins. company & I will qualify to do this for 13 more months. When I get to that point in time, we will probably switch over to the insurance my husband can get through his work. If he didn't have any insurance offered through work, I don't what we'd do- we'd then face trying to go get it on our own & that would be very difficult, expensive, or maybe even impossible. Very sad & this is why our country is looking at national insurance (but let's not go there at the moment-lol!)
*If you are currently working for an employer that you get insurance coverage through, you have the right to continue getting coverage from that insurance company, but you would have to pay for it yourself- but, you'd still have insurance. If you're self employed, then this wouldn't apply to you, unfortunately. If it does apply, then I'd strongly consider doing the COBRA route so that if you left the new job and returned to what you're currently doing, there would not be a lapse in your coverage. It's when there's a lapse in coverage, that people have a hard time getting coverage again (or if they do, they pay an outrageous price).

Paying almost $1500 a month does seem outrageous to me, but my husband and I do this because it's that or nothing. It's hard for me to complain, however, when I see how much they've paid out on my behalf- probably close to a million $ by now. Each month of getting chemo costs about $10,000- which the insurance actually pays out on about $4,000, but that's still a lot of expense paid out over time! I don't think that either my husband or I could go out and get health insurance coverage on our own- I have cancer and he has issues with his heart. We've not actually tried to get it on our own, so who knows, but I bet if we could end up w/ coverage, it wouldn't be as good coverage or we'd pay even more.

Best wishes to you with this! I'll be curious as to what you decide to do.

Lisa

PhillieG's picture
PhillieG
Posts: 4906
Joined: May 2005

Is this your own company or part of an established company?
From what I've read they can not deny you insurance. This article may prove helpful.
--phil

Buzzard's picture
Buzzard
Posts: 3073
Joined: Aug 2008

Its so great to see you pushing right along...Hang tough young man.......Love and Hope to you and yours.......Buzz

Nana b's picture
Nana b
Posts: 3045
Joined: May 2009

I believe if you go 62 or 63 days without coverage you have a pre existing.

tootsie1's picture
tootsie1
Posts: 5056
Joined: Feb 2008

Hey, Mike.

I don't know enough to give you good advice on this, but I hope if you do change jobs, you're very happy. Hope it works out great for you!

*hugs*
Gail

KATE58's picture
KATE58
Posts: 300
Joined: Nov 2009

pre existing usually means that you have been diagnosed
or treated for that condition in the last 6 months.
if it has been longer than 6 months since your last treatment,
and it comes back then it is considered 'new condition'
thats the way it was my last job,I used to help handle the
insurance claims.

Nana b's picture
Nana b
Posts: 3045
Joined: May 2009

http://www.dol.gov/search/AdvSearch.aspx?agcoll=&search_term=63+days+without+coverage&x=0&y=0&taxonomy=&offset=0

You will need a CERTIFICATE OF GROUP HEALTH PLAN COVERAGE from your old plan to

Preexisting condition exclusions. Some group health plans restrict coverage for medical conditions present before an individual’s enrollment. These restrictions are known as “preexisting condition exclusions.” A preexisting condition exclusion can apply only to conditions for which medical advice, diagnosis, care, or treatment was recommended or received within the 6 months before your “enrollment date.” Your enrollment date is your first day of coverage under the plan, or, if there is a waiting period, the first day of your waiting period (typically, your first day of work). In addition, a preexisting condition exclusion cannot last for more than 12 months after your enrollment date (18 months if you are a late enrollee). Finally, a preexisting condition exclusion cannot apply to pregnancy and cannot apply to a child who is enrolled in health coverage within 30 days after birth, adoption, or placement for adoption.

If a plan imposes a preexisting condition exclusion, the length of the exclusion must be reduced by the amount of your prior creditable coverage. Most health coverage is creditable coverage, including group health plan coverage, COBRA continuation coverage, coverage under an individual health policy, Medicare, Medicaid, State Children's Health Insurance Program (SCHIP), and coverage through high-risk pools and the Peace Corps. Not all forms of creditable coverage are required to provide certificates like this one. If you do not receive a certificate for past coverage, talk to your new plan administrator.

You can add up any creditable coverage you have, including the coverage shown on this certificate. However, if at any time you went for 63 days or more without any coverage (called a break in coverage) a plan may not have to count the coverage you had before the break.
Preexisting condition exclusions. Some group health plans restrict coverage for medical conditions present before an individual’s enrollment. These restrictions are known as “preexisting condition exclusions.” A preexisting condition exclusion can apply only to conditions for which medical advice, diagnosis, care, or treatment was recommended or received within the 6 months before your “enrollment date.” Your enrollment date is your first day of coverage under the plan, or, if there is a waiting period, the first day of your waiting period (typically, your first day of work). In addition, a preexisting condition exclusion cannot last for more than 12 months after your enrollment date (18 months if you are a late enrollee). Finally, a preexisting condition exclusion cannot apply to pregnancy and cannot apply to a child who is enrolled in health coverage within 30 days after birth, adoption, or placement for adoption.

If a plan imposes a preexisting condition exclusion, the length of the exclusion must be reduced by the amount of your prior creditable coverage. Most health coverage is creditable coverage, including group health plan coverage, COBRA continuation coverage, coverage under an individual health policy, Medicare, Medicaid, State Children's Health Insurance Program (SCHIP), and coverage through high-risk pools and the Peace Corps. Not all forms of creditable coverage are required to provide certificates like this one. If you do not receive a certificate for past coverage, talk to your new plan administrator.

You can add up any creditable coverage you have, including the coverage shown on this certificate. However, if at any time you went for 63 days or more without any coverage (called a break in coverage) a plan may not have to count the coverage you had before the break.

P_I_T_A's picture
P_I_T_A
Posts: 133
Joined: Oct 2009

There should be no pre-existing rules as long there's no gap in insurance coverage(30 days without,I think.) My wife had end stage renal failure before we got married. I added her to my insurance and 3 months later she had her kidney transplant. Everything was covered because she had COBRA before, just dropped hers and added mine with no break in between, so there was no pre-existing condition.

-DJ

Wenchie
Posts: 88
Joined: Apr 2009

If I remember correctly, if you're enrolling in a "group plan", HIPAA laws protect you regardinig pre-existing conditions. Regardless, if you're leaving a group plan, you are eligible for coverage under COBRA for 18 months. You will pay the entire premium (the amount you had deducted on payroll AND the amount your employer contributed) plus a 2% administration fee. Check to see if the new plan has a pre-existing clause and in the event that it does (but I doubt it) enroll anyways AND keep your old plan under COBRA for the six months it takes to qualify (if the pre-existing clause eliminates you for six months).

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