| Health Insurance; COBRA; OBRA; HIPAA; | | | | you or a member of your family has what is |
| Medicare. If asked, could you state that you | | | | called a "pre-exisitng coverage" condition.Here |
| knew that all 5 of these topics had the same | | | | again, before automatically taking COBRA, it would |
| thing in common: medical insurance coverage for | | | | be wise to contact a Benefits Insurance Broker |
| you and, perhaps, your family? Would you know | | | | and give him/her all of your options, and get their |
| the qualifications for each? Well, in this article, we | | | | input. I have worked extensively with a Benefits |
| will discuss them. For a timeline that depicts, | | | | Insurance Broker, and he is absolutely |
| graphically, the time relationship between them, | | | | fantastic!OBRAWhat, you ask, is OBRA? I've |
| please see the timeline in INSURANCE Coverage | | | | never heard of it, you say, and no one I know |
| from WorkIf we are lucky, we, and/or our | | | | has heard of it either! Well, that's because, 99% |
| spouse, work for a company that provides, as a | | | | of Human Resource or Benefit folks that I know |
| benefit, health insurance coverage for us and our | | | | have never heard of it! OBRA is a federal law |
| family. If so, we are very lucky. Even if that is | | | | that was passed that extends COBRA for an |
| true, there are some key things that you might | | | | additional 11 months FOR DISABILITY PURPOSES |
| want to look at to see if you have ENOUGH | | | | ONLY!! Why, you ask, is this important? Thanks |
| coverage.1) From your Human Resources | | | | for asking, let's see if I can explain.If you are as |
| Department (or wherever else you would go to | | | | nieve (did I spell this wrong too? sorry!) as I was |
| get information about your health insurance) get | | | | when I first started looking to bridge my health |
| what is called a "Summary Plan Description" (SPD). | | | | insurance from working to Medicare, I assumed |
| This document should be kept where you can | | | | that when I got through all of the hoops to qualify |
| always find it, as it contains all the information you | | | | for SSDI (Social Security Disabililty Insurance) I'd |
| will need about what your insurance covers and | | | | IMMEDIATELY be eligible for Medicare, RIGHT??? |
| what it doesn't.2) Look up "Coverage" and | | | | WRONG!!!!When you FINALLY qualify for SSDI, |
| "non-coverage" in your SPD.These will tell you | | | | you have to wait for 5 months before you get |
| what your plan covers and doesn't cover. You | | | | your first check. AND, the rules state that, you |
| need to see if, perhaps, you or one of the | | | | are eligible for Medicare 2 years (24 months) |
| covered members of your family has a condition | | | | FROM THE DATE OF YOUR FIRST SSDI |
| or circumstance that might not be covered, | | | | PAYMENT. Well, if you add 24 + 5 you get, 29 |
| where you need additional coverage. For example, | | | | months between qualifying for SSDI, and |
| let's say that your family has a history of cancer; | | | | Medicare coverage.OK, I said earlier that COBRA |
| perhaps your plan restricts the number of | | | | is for 18 months of coverage. Well guess what 18 |
| hospitalization days for care; or, restricts the days | | | | months of COBRA + 11 months of OBRA equal - |
| per condition. In this case, (like my children) you | | | | 29 months!BUT, there are two catches to OBRA; |
| might want to get additional "cancer insurance" (I | | | | first of all, you have a small window of 30 - 60 |
| think that AFLAC might provide this type of | | | | days to apply ( this window opens the date of |
| coverage).It would be a good idea to contact a | | | | your SSDI approval); and, it can cost up to 150% |
| Health Insurance benefit Broker and ask him/her | | | | of your plan coverage amount. BUT, if you have |
| to read your SPD and see if you have any gaps | | | | a "previously existing condition" this might be the |
| in coverage. They then can help you supplement | | | | best way for you to proceed.Again, it is important |
| coverage BEFORE YOU NEED IT!NO HEALTH | | | | to contact a Health Insurance Broker to help you |
| INSURANCE COVERAGEYou might be one of the | | | | with the risk/cost ratio of all of these situations.It |
| growing members of our society that, through | | | | is also improtant to know all of these deadlines as |
| one circumstance or another, does NOT have | | | | you plan to ensure that you and your family have |
| health insurance coverage for your family. In this | | | | important health insurance coverage.HIPAAHIPAA |
| case, I strongly encourage you to contact a | | | | is a federal law that is called, briefly, the |
| Health Insurance Broker and get immediate | | | | "portability" law for health insurance. What that |
| coverage of what is called "catestrophic" (not sure | | | | means is that when you leave a group (read |
| if I spelled this correctly) coverage. In this type of | | | | company-paid plan), the carrier that provided that |
| coverage, you will generally have large deductibles, | | | | plan, must offer to you, another plan, different |
| but will have coverage if, say, one of you has to | | | | from COBRA, when you leave the group |
| go into the hospital.CONTACTING A BENEFITS | | | | coverage. Generally this will be what is called a |
| INSURANCE BROKERWhenever you call or email | | | | "bare bones" plan. Again, the best thing for you to |
| a Health Insurance Broker, it is very important to | | | | do is to call/email a Health Insurance/Benefits |
| prepare ahead of time. WHAT, specifically are you | | | | Broker with all of your information: SPD, COBRA |
| looking for; how much can you afford to pay | | | | info, HIPAA info, needs, cost limits, and let him |
| every month; what circumstances do you want | | | | her help you find the optimum plan coverage for |
| to make sure that your family is covered for. In | | | | you.MEDICAREOK, now, finally, we've reached |
| this way, you can make sure to focus on your | | | | Medicare! BUT (you really didn't think it would be |
| critical needs.COBRACOBRA is an acronym ( how | | | | that easy, did you?) if you have qualified for |
| can I spell acronym correctly, yet not be sure | | | | Medicare because of disability, there are |
| that I spelled catestrophic correctly?) that stands | | | | RESTRICTIONS (of COURSE there are!).First of |
| for: Consolidated Omnibus Budget Reconciliation | | | | all, if you are qualifying for Medicare because of |
| Act. Basically, it is a federal law that allows you to | | | | disability, you are probably under the age of 65 - |
| pay for your Company-paid health insurance, as | | | | normal retirement age.Medicare coverage does |
| an active member, if you no longer work for that | | | | NOT cover prescription drugs, which, those of us |
| company for, generally 18 additional months.1) | | | | with disabilities probably need, and which cost |
| COBRA is "triggered" (that is, you, or a covered | | | | lots.But, Congress prescribed that states (all but |
| member of your family, become eligible for | | | | 11) offer what is called "Medicare supplement" |
| COBRA) by events such as the following: | | | | plans, some of which do offer prescription |
| resignation from the company; termination (FOR | | | | coverages. |
| ANY REASON) from the company; divorce of a | | | | BUT, these plans ARE NOT REQUIRED TO, and |
| spouse; a covered chile's birthday makes them | | | | do not, offer these medicare supplement plans |
| ineligible for coverage. These are the main | | | | that offer prescription coverages to folks who |
| "triggering" events for COBRA.2) Now, when | | | | qualify under age 65! So, if you are qualifying |
| eligible for COBRA, you will be asked to pay for | | | | because of disability, your medical insurance plan |
| 100% to 105% of the company's employee | | | | doesn't cover one of your primary cost |
| employee and family coverage amount. You | | | | expenditures!Here again is where you need to |
| should get a letter from your company explaining | | | | contact a health insurance/benefit broker. Again, |
| what that amount will be. BEFORE YOU DECIDE | | | | he/she can work with you, and your specific |
| TO TAKE COBRA, there are some important | | | | circumstances, to get you the coverage you |
| things for you to consider.What will be your cost, | | | | need.Hope that this information was helpful to you. |
| and what will be the coverage for that cost? | | | | If you have any questions, please feel to ask |
| Sometimes the cost is too much for the | | | | them by commenting on this blog, and I'll be |
| coverage. In these cases, you might want to | | | | happy to get you an answer.About & Carolyn is a |
| select HIPAA coverage, instead (see HIPAA | | | | website designed to assist each person in his/her |
| below).Or, you might just want to get | | | | own unique quest to navigate through the difficult |
| catestrophic coverage as was mentioned earlier, | | | | and often conflicting and misleading information |
| and wait for full coverage under your next | | | | about coping with disabilities. |
| job.Part of this decision should be whether or not | | | | |