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