Insurance/Changing Jobs

[Hebbie]

Has anyone out there switched jobs since their diagnoses? I have a great opportunity to leave my high-stress law office job and take on a job at a very small company as their operations manager. It's a newer company and they don't offer benefits yet. (The appeal of this position is that my hours could be worked around my son's school schedule and it doesn't require the hour long commute each way that I have now).

I can go on my husband's group insurance plan at his job, but I am concerned about that. Can I be denied coverage through some strange pre-existing condition loophole? Can they take me on the plan, but later start denying things?

Anyone have any experience with this issue?

Thanks!

Heather

[Elaine]

Hebbie

As long as you have had continuous coverage, they can't deny you benefits or impose a pre-existing condition.

The one thing, however, that you need to find out is if there are any restrictions as to when you can be put on his coverage. You should check with his HR dept and/or with the insurance company itself.

Elaine

[MO_Sugar]

In my company, as long as you have had continous coverage prior to coming on the plan, they will cover you. I am sure each company is different but I would ask the HR dept to go over every thing before making the move. You may be able to go on his policy now and make a move at a later time? I hate the thought of being wothout insurance! Scares me worse than cancer did!!!

Prayers and best wishes being sent your way!

God Bless,

MO

[Frank Lamb]

Hebbie,I can't answer.This disease so far has ended my working.I do know insurance co's have lots of loopholes etc.When I was diagnosed I had just switched jobs and had no ins. at all.

Good luck I'm sure everything will work out for you.

[gerbil runner]

Better to be safe than sorry. Get all the paperwork you can find on you husband's plan. Check "pre-existing condition" clauses carefully. Some plans will exclude unless you join during an "open enrollment" period.

Another thing - some small employers can really be blasted out of the water by insurance premiums should an employee/spouse have a catastrophic illness. It is not unheard of for the employee/spouse in question to be released if that happens, because the employer can't find/afford insurance with the sick person in the risk pool.

It's totally unfair. The only party which doesn't suffer in such a case is the d@mn insurance company.

In short, I'd be careful if your husband works for a small company. I'm not knocking small companies - I own one, with my husband. We get our insurance through the local Chamber of Commerce to avoid that very problem - we only have 7 employees.

[Elaine]

What gerbilrunner says is true. My husband works for a small company and I am so afraid they will find some reason to let him go. It would be against the law to do it, but maybe they will find some excuse??? I live with the fear daily.

[Hebbie]

He works for Citigroup/Smith Barney, so I guess you could say they are a larger company! He's printing out all of the information for each of the different plans offered. Since we were recently married, I believe that is considered an event that allows him to add me to his coverage, but I will verify that. Otherwise, we will need to wait until November when they let him do open enrollment again.....

I really appreciate all of your responses!

Heather

[Andrea]

Heather-- A law firm? High stress? nah, you must be imagining it. Hahaaha. I am so funny. So funny that from the stress I might go to a funny farm

My understanding that as long as you have continuing coverage, you cannot be denied b/c of a pre-existing condition. That said, I am not sure if they could raise your rates, etc. But I do not believe they can deny you coverage.

As for the wedding being a life changing event, check the time line on it. I wanted to switch to Brian's ppo b/c like an idiot I chose HMO here and there is like a 3 month window. I legally got married in Nov even though Feb was the wedding, so I am out of luck until open enrollment.

Elaine--As for retaliation and firing b/c of cancer, they CANNOT and MUST not do that. You can fire someone b/c they are wearing a pink or red shirt. But not b/c of race, religion, gender, national origin, age, or disability. Of course proving the reason someone is fired or laid off is what keeps me in business, I do employment defense But in reality, they cannot fire someone because of it. If something "fishy" goes on at work, where suddenly your hsuband gets warnings or gets written up for no reason, have him document it and keep it so he can prove that he was set up and then he can sue. But it rarely happens. So don't worry

[Guest Billie]

I believe if you check the "Americans with Disabilities Act", you will find that a large company that offers group health coverage cannot deny coverage to anyone, even if there is a prior condition.

Billie

[cherbut]

Hi, Heather,

Did you get a definite answer in regard to coverage from your husband's insurance company? Anytime I was especially concerned about getting a CORRECT answer (like whether Iressa is covered by my Rx card) I would document the date, name of the person I spoke with(normally they just give their first name), and I would ask that they make note (keep the tape of the conversation or whatever it's called) in case of questions later. I wonder if you could get it in writing.

Cherbut (Cheryl)

[karen335]

Hi All,

Just talked to my husband about his insurance. He works for a small company. The insurance is blue Cross or Blue Shield. The quoted monthly premium for PPO to add me is an additional $900.00 per month for just me and the HMO is $1,000.00 just to add me. This is outrageous. His open enrollment is in May, I can be added then or wait til my Cobra runs out in Oct. and then I can automatically be converted over. I pay $244.00 per month now for insurance with Cobra (Cigna). I worked for a company that had 176 employees...

What is one to do? This is not fair at all. I

Does anyone have any ideas, insurance experience or ????

We are all desperate for answers regarding this subject...

God Bless

Karen

[kimblanchard]

Most insurance companies do have limited times when you can join the plans, but almost all of them include changing jobs or losing jobs for spouses. You can also always change your coverage when there has been a marraige, divorce, or child born, for example.

Curtis

[Guest]

Heather,

I work for Citicards. Your husband can put you on his insurance within 30 days of a "life event"

1) Marriage

2) Change of insurance eligilibility (employment change)

2) Birth of child

4) Divorce

5) Adoption of child

Look at the coverages closely. You will both have to carry the same coverage, by the same insurance company. I have United Healthcare which covers most all providers in Texas. You might also look into a healthcare spending account. This is pre-tax dollars you can use to pay deductibles, co-pays and prescriptions.

Jerrye

[Guest Karen C]

Just thought I'd add my two cents worth here. For one thing, I would call the insurance company and the HR department directly and quiz them on adding you to their coverage and if they have any pre-existing condition clause. Another thing - if you change jobs, from one job with insurance coverage to another job without insurance coverage, that is considered a life changing event and they should add you to your husband's policy.

Dave has been on an HMO with his employer since he's been at this job (six years I think) and I've been on a straight up, no referrals needed, cover everything blue cross/blue shield at my job for four years now. I work for a huge public utility company. We decided to add Dave to my coverage for this new year and keep his HMO, just to make sure anything and everything he ever needs done or prescribed is covered. (our favorite hospital is out of network on his plan but not mine. our allergy doc doesn't participate with his HMO, etc. - his prescription coverage is cheaper but mine covers alot of drugs that his does not, etc. etc.). Anyway, I called to check before adding him for this year and was told we have NO pre-existing coverage at all - that even if he was in the middle of a chemo treatment or something they would pick right up and cover it. Not bad. So it's always worth checking, and there should be no harm in asking.

I hope this reply isn't too late to be helpful, I just saw the post.

Karen C. (David C's wife)

[Guest Karen C]

p.s. Dave might be switching jobs himself, too. we'll see how it goes. this is a good story. he works for a mortgage company. his company fired one of their executives and she had signed a no-compete clause. but after it expired, I think two years, a new mortgage company came to town to open an east coast operations and hired her to run it. she immediately started stealing employees from her old company where Dave works. She is well liked by the masses there (pretty much got fired in a management change - long story). Anyway, they offered Dave a job with a $12,000 raise and he accepted. He was going to give his notice at work - this is one year ago - and was sick that Thursday and Friday and didn't go to work and I think he was going to give his notice on Friday. On Saturday I took him to the hospital where he was diagnosed and started chemo that week while still in the hospital. The new company didn't have great benefits at the time and had a 90 day wait for any new employee on health insurance coverage. He also found out that on their disability plan, because of his pre-existing condition he'd have to wait two years because of his cancer to be covered on it. But he had good disaibity coverage at his "old" job, etc. etc. so he called the new company, told them what was going on, and didn't give his notice. The new company told him the job would be waiting for him whenever he wanted it. And you know, at least every month or so someone would call him from there to see how he was doing. Well, once he found out about the disability pre-existing condition thing he just decided he couldn't make the switch - we need him to be as covered under everything possible as we can. Well, now they are ramping up their benefits and the VP had someone call him last week and tell him they were pretty sure he'd just have a 90 day wait on the disability coverage now. The job is still there, and the raise in pay is still there. He has a PET scan scheduled for May 3, and I told him if that looks good I am all for him seriously considering taking the new job. He's on my health insurance now so that won't be a problem for those 90 days. if he has a clean PET scan then we should be safe waiting for 90 days for disability coverage to kick in. the only thing would be his life insurance. He's got the max coverage he can get at his job but he probably would have to work his way up through coverage levels at the new job. I know at my company and the law firm where I used to work, ever year you can increase your own life insurance by one or two levels without any medical certification. so both of us have inched our way up to max coverage.

My company used to own his company, so the attorneys I work with here (in house legal dept) knew all about this and knew all the executives and the ongoing soap opera between the two mortgage companies. I remember my first day back to work last year after he was hospitalized - a couple of my gal lawyer friends - the first thing they asked me was - did he give his notice? does he still have the old job? pretty funny.

OK, sorry for the ramble, but it brought back that whole story.

Karen C.

[Guest fsmith]

I am in a job where the family medical leave is 16 weeks unpaid. I am also suffering from depression and anxiety since my husbands diagonosis of nslc stage iv, not responding to chemo and very sick. I have two children 9 & 10 and have not been effective at work since his diagosis in april 2004. He has now been advised, based on the last ct scan that chemo therapy and radiation have not reduced 6 tumors and in fact some have gotten larger. Does anyone know about disability for the caregiver when she is suffering from maladies that require medication? I am also the one who holds the health insurance and life insurance through my company.

[betplace]

I wish I had a response for you. I know of at least one person who is on SSD because of Depression. But it is not an easy thing to get. Maybe Norme might have a couple answers for you. In thwe meantime please accept my prayers that things ease up for you all very quickly and you get a better handle on things.

Blessings

Betty

[SDianneB]

Here's my advice:

Find out about the new plan -- does the employer offer self-insured benefit plans? If so, then they are more than likely covered by federal ERISA law rather than your own state law regarding eligibility and coverage.

If it is an ERISA/self-insured (also called self-funded) plan, then request, in writing, a copy of the plan documents. (ERISA law obligates them to give these to plan participants on an annual basis or upon request.) You may need to take the plan documents to someone familiar with insurance terminology and coverage, but it will be well worth it to know exactly what is/isn't covered in this plan.

If it isn't an ERISA plan, then request a copy of the plan documents/policies, and do the same thing -- have them reviewed and analyzed as to coverage, eligibility, etc.

While going through these documents, make a list of all questions you have, even if you think they may be silly! Then, go to the plan administrator or person in charge of benefits with your questions and ask them all and make sure you get answers.

If it isn't an ERISA/self-insured plan, your state will have an Insurance Commissioner and an office that oversees compliance -- contact them if you think the plan has rules that are contrary to state law.

Also, contact someone in a large hospital in your area, in the business office. They know all the resources in the state, will probably know all about the plan already, and can tell you about state & ERISA regs pertaining to claims payment, because they deal with this stuff every day.

There's no such thing as too much information about health insurance!

Di