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