Q. I am receiving health insurance benefits under the COBRA law and was told that I must buy other insurance two months before my COBRA stops, and I must have both plans in force at the same time for two months. I can’t afford to pay for two health insurance plans at the same time. What do I do?
A. The law is very specific. You can only have one health insurance plan in force. You cannot have similar plans that duplicate benefits. The goal is to purchase health insurance that becomes effective the day your COBRA coverage expires. Ideally you should put the application in a month prior to when you need the new coverage to become effective, but with an effective date for the day your COBRA ends. You can apply for coverage earlier, but with the proper effective date. That way you will not have a duplication of benefits (or premiums!) and will not have a gap in coverage either.
Q. My husband and I were on a European cruise when he got very sick and was taken off the ship and admitted to a hospital in Italy. I have a detailed itemized bill from the Italian hospital, but Medicare will not pay for it. What do I do now?
A. If your husband has a good Medicare supplement, it will pay 80 per cent of the actual charges after a $250 deductible. However, the bill must be translated into English. It is the responsibility of the insured to present the insurance company with a bill they can read. You will also need to know the conversion rate of exchange for currency on the date the services were rendered. This information can be obtained from either your local bank, or often newspapers have the exchange rates. If you are internet savvy, I am sure you will find a website that contains this information. Keep in mind that the exchange rates vary from day to day, and you need the rate for the date services were rendered.
Q: I have Medicare, and a Medicare supplement, yet I keep receiving bills from the hospital and doctors. My question is why, when I have insurance?
A. Did you submit the claims to the Medicare supplement? The providers are responsible for submitting claims to Medicare, and some will submit to your secondary carrier as a courtesy. However, they are not obligated to. If they have not been submitted to your Medicare supplement, submit them now! The other scenario could be that your Medicare supplement paid YOU and you now need to pay the doctors and hospital.
Q. I recently applied for individual health insurance as my COBRA is about to run out. Will the insurance company do a background check on me? Will the insurance company send someone to my house for a blood test and physical?
A. The answer is simply no. In New Jersey, health insurance is not medically underwritten which means the insurance company cannot turn you down based on your medical history, nor do they do background checks as long as you can prove that you were continuously insured for the last twelve months, you will not have a waiting period for any pre-existing condition.
Q. I have been living with a woman for the past 15 years and want to include her on my insurance policy. Can I do that even if we are not legally married?
A. No. In order to receive the benefits of spousal coverage, you must be a legal spouse. There are some states which do recognize same sex partners for spousal benefits, or domestic partners, but not NJ. You must be married to qualify for spousal benefits.
Irene Card & Betsy Chandler share the responsibilities of running Medical Insurance
Claims, Inc. a health insurance services company. If you have questions relative to this
column or other related topics, we invite you to call (973) 492-2828, browse our
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