Group Health Coverage - I may be changing jobs, whose health plan covers my wife's current cancer treatment?

Question

She will be facing six months of chemotherapy and follow up doctor visits. Our current provider covered a January surgery and hospital stay and has been great. Would my new employer's plan typically cover a pre-existing condition?

Answer 1

Your question pertains to the Health Insurance Portability and Accountability Act (HIPAA), assuming you're US residents and you'll be working in the US.

The answers you've received so far leave out one vital piece of information: lapse period between coverages aside, the answer to your question depends ENTIRELY on how long your wife was covered under a group-based plan. If she has been covered for AT LEAST 18 months by her current (and/or any previous group-based health insurer, with a lapse in between of no more than 63 days) she can apply this as a "credit" against your new employer's plan. Shortly after your current coverage lapses, your insurer must mail you a "Certificate of Creditable Coverage." This will list how long she was covered. The Certificate must be given to the new insurer so it can credit her past coverage against the new pre-existing condition exclusionary period (if any).

Examples:

1) Your wife was covered for 20 months under your current plan; her insurance through your new employer is effective immediately and has a pre-existing condition exclusionary period of 12 months. After receipt of the Certificate of Creditable Coverage, your wife will NOT be subject to a pre-existing condition exclusion.

2) Your wife was covered for 9 months and has no previous creditable coverage. If the plan has a 12-month pre-existing condition exclusionary period, services incurred after her 3rd month of coverage will be covered.

3) Your wife was covered 9 months under the current plan and 5 years under a previous plan; there was a period of 30 days between the two coverages. Upon receipt of both Certificates, she will have no pre-existing condition exclusionary period.

This is a fairly complex law and I've only been able to summarize. For further information, go here:

http://www.dol.gov/dol/topic/health-plans/portability.htm

Answer 2

If you have a lapse between the time your new employer covers you and your wife, you must apply for Cobra coverage. You will have to pay the premium on your own until your new employer picks up the insurance. It will ensure that there is no lapse in coverage between the time you/she were not covered by your new employer. Make sure that you address this situation tomorrow with your employer before you change jobs. If there is a lapse between coverages, you may be subjected to the "previous condition" policy. Hope everything turns out great for your wife, bless her heart.

Answer 3

As long as there is no lapse in coverage - meaning your current policy ends the day before the new one takes effect, then they should pay for it, under continutiy of care. If you might have a lapse, pay for COBRA coverage - it's worth it to shell out a couple hundred a month rather than hundreds of thousands later.

Good luck. I hope your wife recovers well.

Answer 4

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Answer 5

There is a great way to be covered in the interim very inexpensively. www.mybenefitsplus.com/ewarner. They accept all pre existing conditions no questions asked

Answer 6

as long as their is no laps in coverage, your wife should be o.k. if the new plan would cover new plan the treatments like her old one.good luck for your wife.