Insurance Question

[PlacentiaSoccerMom]

I have a friend whose husband changed jobs two weeks ago.

She was told that it would take 30 days for her new insurance to kick in. In the meantime, she has the option for Cobra from her husband's old job, but she won't get the bill for quite a while. Her intention, after talking to friends and HR people would be to pay the Cobra bill if she needs to, but otherwise go without insurance if she doesn't have a problem. (There are about two weeks until her new insurance kicks in.)

My friend had Breast Cancer five years ago that was completely cured.

A mutual friend said that since my friend has a pre-existing condition, she should pay the Cobra and get proof of coverage for that 30 day period, just in case somebody later on says that the cancer started during that 30 days.

Does anyone have any thoughts about this matter?

[kayrharris]

The certificate of creditable coverage is pretty important when it comes to pre-existing conditions. I'd pay it, if it were me.

[SportsFan68]

I have a friend whose husband changed jobs two weeks ago.

She was told that it would take 30 days for her new insurance to kick in. In the meantime, she has the option for Cobra from her husband's old job, but she won't get the bill for quite a while. Her intention, after talking to friends and HR people would be to pay the Cobra bill if she needs to, but otherwise go without insurance if she doesn't have a problem. (There are about two weeks until her new insurance kicks in.)

My friend had Breast Cancer five years ago that was completely cured.

A mutual friend said that since my friend has a pre-existing condition, she should pay the Cobra and get proof of coverage for that 30 day period, just in case somebody later on says that the cancer started during that 30 days.

Does anyone have any thoughts about this matter?

Yes. Read the fine print on the new policy. Sometimes a pre-existing conditions exclusion goes away after a year. Sometimes it doesn't.

The 30 days don't matter -- she has a pre-existing condition. Some docs will tell you that there is no "completely cured" when it comes to cancer, and if she gets cancer later on, and if the insurance company decides to do battle, it is certain that a doc can be found who will say that it is the same condition.

If we were talking about a healthy mountain biker in the same situation, she should as you originally describe. Even if she dumped her mountain bike over a cliff with her on it and broke six bones and her spleen during the non-covered two weeks, COBRA time limits are very generous and would give her plenty of time to get the accident covered.

[silvercamaro]

I agree with Kay and Sprots. In this case, the Cobra premium is the cost of insurance on the new insurance. (She can count herself lucky that she only has to pay for one month at the Cobra rate, but she needs to maintain provable continuous coverage in the chance that becomes an issue at some point in the future.)

[kayrharris]

I'm not so sure about that. HIPPA has some pretty strict rules you have to follow. Here's a bit of info:

Creditable Coverage
The concept of creditable coverage is that an individual should be given credit for previous health coverage against the application of a pre-existing condition exclusion period when moving from one group health plan to another, from a group health plan to an individual policy, or from an individual policy to a group health plan.

An individual will receive credit for previous coverage that occurred without a break of 63 days or more. However, any coverage occurring prior to a break in coverage of 63 days or more would not have to be credited against a pre-existing condition exclusion period. (Some States' laws may provide greater protections.) If 63 days pass without coverage, then the 12/18 month period starts over.

Or go to this web site:

http://er.hipaaps.com/hipaa_portability.htm

[silvercamaro]

I yield to Kay, who is my authority on All Things Insurance.

[kayrharris]

I yield to Kay, who is my authority on All Things Insurance.

Thanks for the vote of confidence, but there are exceptions to almost everything. However, in this case as we know the facts, I would pay the Cobra premium.

[SportsFan68]

I yield to Kay, who is my authority on All Things Insurance.

Thanks for the vote of confidence, but there are exceptions to almost everything. However, in this case as we know the facts, I would pay the Cobra premium.

I would too.

Tomorrow I'm gonna go dump my mountain bike over a cliff.

[marrymeflyfree]

I'd pay it. One month of COBRA isn't fun, but it's better than the stress of not knowing how not having it may affect her coverage later if she were to have a recurrence of her cancer.

I'm having an un-fun insurance day, too. My coverage switches to COBRA for my year of maternity leave, and I just got the first bill today. I'll go on The Naughty Norwegian's policy when we tie the knot, but we don't want to rush things just for the cheaper insurance. My company offers domestic partner benefits for gay couples - I need to check out the fine print to see if heteros can partake. If not...well he is very against the idea, but I'm considering going uninsured. The cost for the whole year is absurd.

[kayrharris]

I yield to Kay, who is my authority on All Things Insurance.

Thanks for the vote of confidence, but there are exceptions to almost everything. However, in this case as we know the facts, I would pay the Cobra premium.

I would too.

Tomorrow I'm gonna go dump my mountain bike over a cliff.

Yikes! I hope you have good health insurance.

[TheConfessor]

She should probably pay for Cobra insurance for a month, just to be safe.

She'll probably never need it unless she plans to walk barefoot through the jungles of India.

[gotribego26]

I yield to Kay, who is my authority on All Things Insurance.

Thanks for the vote of confidence, but there are exceptions to almost everything. However, in this case as we know the facts, I would pay the Cobra premium.

Based on my experience I would disagree:

First off in most cases COBRA coverage is not creditable coverage. I learned this the hard way. It is a loophole that TPTBs are aware off but haven't fixed. (this is often a reason to skip OCBRA and look for creditable coverage if you anticipate a long period of no coverage)

Secondly - 30 days fall within the 63 day rule - so she can afford to save the money from that standpoint.

The final and most important thing is that the rules for the first payment of this coverage are very lenient - in most cases you are not even billed within the 30 days. If you are billed the due is day 60 (and coverage is retroactive.) If you've made it past the 30 days with no incidients (visits to a doctor or accident/injury) you can save the money.

Regarding protability, you should have a certificate of prortability from your prior coverage (carrier or emloyer). If you don't have it find out when it is coming - also talk to your new provider on pre-existing coverage - while HIPPAA sets minimum standards some states have laws that work more in your favor.

In summary you are taking no risk by waiting to see what happens.