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