Another interesting week here at MIC has produced some questions from clients or column readers that we would like to share with you.
Q: My employer lapsed our group health insurance because he did not pay the premium for 6 months - he put a new plan in place but I do not trust him to pay the premium - can I opt out and buy my own insurance?
A: When you are eligible to be covered under a group health insurance policy, you are not eligible to purchase an individual plan. Nor would you really want to, although I can appreciate your concern. However, group health insurance offers better coverage for less premium dollars. If you are concerned about the employer paying the premium, you may wish to check with him/her occasionally on whether or not it has been paid.
Q: My wife just died of cancer - I have a $47,000.00 hospital bill that my insurance company is rejecting stating it was a pre existing condition - can they do that?
A: Yes. Further discussion with the gentleman who had this question revealed that he had only purchased the insurance plan a few weeks prior to confirmation of her cancer diagnosis and they did have knowledge of the suspected condition prior to purchasing the insurance. His wife had not had previous coverage. If she had prior coverage she would not have had a waiting period for pre-existing conditions and he would not now be faced with raising three children as a recent widower, and facing $47,000 in medical bills. As we so frequently mention in this column, you cannot wait until the house is on fire to purchase homeowners insurance and you cannot wait until you have a medical condition and then buy health insurance and expect the company to pay the bills for the pre-existing conditions. The laws have changed dramatically over the past few years and protect people with pre-existing conditions more than ever. However, if you have had a gap in coverage you will have a waiting period for pre-existing conditions of up to one year.
Q: My husband is 68 and I will be 65 in a few months. Rather than go on Medicare and have a Medicare supplement can we go on our son’s health insurance plan as he works for a very big company with excellent coverage?
A: Simply stated, No. When it comes to medical insurance, you can cover dependents on your plan only as follows: Spouses, children, and stepchildren.
Q: I recently quit my job but will continue my benefits under the NJ Continuation law. My former employer is telling me that I have to make the check for my insurance payable to his company instead of to the insurance company - is this OK? I do not trust him to pay the premium. Can I send it directly to the insurance company instead?
A: What your former employer is telling you is correct. If you continue benefits under either the State law, NJ Continuation, or the Federal Law, COBRA, you will make the check payable to your former employer and he/she will in turn pay the premium to the insurance company. The reason for this is that the insurance company is sending ONE BILL to the employer for all the people who are presently on the plan as active employees or continuing benefits under either law. Therefore, the employer needs to make one check payable to the insurance company to cover that entire amount. No, you cannot make your check payable to the insurance company and send it them instead for the reasons mentioned above. If you work for a company with 20 or more employees, you will be eligible to continue your benefits under the COBRA law. If that is the case, you might make the check payable to your former employer Or, some employers will hire a company to administer the COBRA in which case the check would be made payable to that company, i.e., COBRA SERVE or COBRA COMPLIANCE.
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 past columns on our web site at www.micinsurance.com.
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