question

[Margaret]

If Boyce and I, during a qualifying event, join my group insurance plan through my company....will they cover his cancer treatments?

I was hoping on a group plan, there would be no pre-existing conditions. I am just not sure how joining a group plan works.

I keep seeing this little, "have you ever had cancer" BOX, that we are going to have to check off. I hope not.

Thanks!!

[Fish]

Hi Margaret:

That's a tough question and I suspect you will have to read the fine print very carefully. I believe it will vary from company to company. I'm a federal employee, and I'm fairly certain the gov requires that ins companies that offer coverage for feds cover pre-existing conditions, but at a previous job pre-existing conditions were not covered until after 12 months on the policy.

You should be able to go the the website of your group plan. If the info is not spelled out, you might have to call the provider. Personally, I would try to get something in writing. But then I am a suspicious person

I hope you can get coverage right away.

Fish

[SleepyGuy]

I was hoping on a group plan, there would be no pre-existing conditions. I am just not sure how joining a group plan works.

As long as there is a benefit for cancer treatments, the new policy will have to cover the treatments. As long as he hasn't been without insurance for 60 (maybe 90) days, he should get covered. But if there was no insurance before, then usually you have to wait a year before they will cover pre-existing conditions. Although this period could be different from policy to policy.

[Margaret]

Thanks guys....he has not been with out insurance so it sounds like we may be okay.

[emilyalex]

Margaret - as long as Boyce doesn't have a 63 or more day break in continuous medical coverage, he should not be excluded for his cancer treatment by another plan. In addition, him losing coverage as a UHC employee entitles you to make a qualified family status change. Make sure you get the family covered through your plan within 31 days of his loss of other coverage. I would also suggest contacting someone in the UHC benefits department or ask the HR people to give him a HIPAA certificate, or letter of creditable coverage. This is something that typically gets sent from the insurance provider, but it can take several weeks and you need to have the HIPAA cert on hand just in case the new plan asks for it. More than likely they won't, but better safe than sorry.

There should be no questions, at least on the medical insurance side, regarding whether or not the participant has previously been diagnosed with or treated for cancer. Now that's different with life insurance, and I'll get to that next.

When you add him to your plan, check with your employer to see what "guaranteed coverage" is available. For example, my employer provides up to $30K of spouse life coverage without medical evidence of insurability, which is where the have you had cancer question would come into play. Your company's plan should have some built in guaranteed coverage and I suggest signing him and the family up for whatever you can while you have a qualified family status change. Often you can make some changes like this during an open enrollment period, but the guaranteed issue without med insurability may not still be offered. You may also get some child life coverage for your little one. My company offers $5K per child, no medical questions.

I'll PM you my phone number if you have any questions while signing up with your employer. I work as a Benefits Specialist in Human Resources, so I deal with this stuff every day.

Emily

[Mom]

I had lunch with my health insurance broker today and asked her your question. She said as long as you go from one group plan to another and there is no lapse in coverage greater than 63 days he is covered for pre-existing conditions. This is a federal law, not a state law. Dianne