KEEPING MEDICAL INSURANCE WHEN YOU CHANGE YOUR JOB

KEEPING MEDICAL INSURANCE WHEN YOU CHANGE YOUR JOB
by Roger V. McCaffrey-Boss
Copyright by Gay Chicago Magazine and Roger V. McCaffrey-Boss
April 2-8, 2009
http://www.gaychicagomagazine.com/advice/legallyspeaking.shtml


Q: I am HIV-positive and want to get a better job. Will I be able to get medical insurance at my new job?
A: Medical insurance usually contains a pre-existing condition clause. For a certain period of time after you begin coverage under an insurance policy, benefits may not be paid for the treatment of conditions you had before the policy took effect.

To avoid “job-lock” (being locked into your current job) it is important to know and understand your rights under the Consolidated Omnibus Reconciliation Act, known as Cobra (last week’s article) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Under HIPAA, employers’ health-care plans cannot exclude a new worker’s pre-existing condition from coverage for more than 12 months. Before the law’s enactment, some health care plans excluded pre-existing conditions permanently.

If you are HIV positive and it is known by the insurance company from your old employer that you are HIV positive and you have been covered by your old employer’s insurance company for more than 12 months, your HIV status will not be considered a pre-existing condition for your new insurance company. You will have health insurance on the first day you start your new job.

When you leave your old job, for whatever reason, all employers with two or more employees that offer health insurance must notify former workers that they are eligible for certificates of coverage that would verify previous health coverage for new employers. New employers can only exclude coverage for medical conditions that have been newly diagnosed or treated within the 6-month period before the employee enrolled in the health care plan at the new job. However, the exclusion from coverage cannot be for more than 12 months.

Also, if you have been covered by your current plan for at least 12 months, without a 63 day break in coverage, your new employer will not be able to impose the 12-month pre-existing exclusion period when HIPAA becomes effective for your plan. The 12-month exclusion time period is reduced by the time an employee was enrolled in an earlier health plan at the old job. The 12-month limit on excluding pre-existing conditions is shortened by the length of any period of continuous coverage the individual had with his or her pervious employer. Continuous coverage is that which is not interrupted for more than 63 days.

For companies with 20 or more employees, certification statements detailing when the employee and any dependents were covered under a previous plan must be provided to the worker within 14 days after his or her leaving. Firms with fewer than 20 employees must provide such certificates “within a reasonable time frame,” according to the law. The certificates are the responsibility of the employer, the insurer, and/or the group health plan such as a health-maintenance organization.

Another important aspect is the flexibility of employees to enroll themselves or their dependents in the company health plan before the next enrollment period with no penalties. This would occur if an individual had delayed signing up for the new insurance, perhaps because of being covered on a companion plan.

Also, because many plans do not exclude coverage for pre-existing conditions, your new employer must tell you if their health insurance plan has a pre-existing condition exclusion period and can only exclude coverage for a pre-existing condition after you have been notified. The plan must also notify you that you have the right to show that you have prior creditable coverage to reduce the pre-existing condition exclusion period.