blue cross health insurance through employer question

[elegantlion]

My dh started a new job today (yea!). He's been self-employed for years and we are currently uninsured. The employer offers blue cross, but I wonder if they can turn down a spouse of an employee due to pre-existing conditions. Or would that simply not be covered for a 12 months (or some mandated period).

 

I had cancer about 17 years ago (we had insurance at the time). Would they deny coverage long term complications arising from the condition? I have a few issues, one that is definitely from one of my surgeries(scar tissue), the others could possibly be blamed on radiation tx. They haven't been enough to see a doctor yet, but could become issues down the road.

[Rivka]

Employer-provided health insurance is not allowed to refuse to cover an employee's immediate family. There may be a waiting period for pre-existing conditions, but they aren't allowed to just refuse to cover them.

[Annie G]

I don't know- but we have Blue Cross through dh's employer and last year he got a new boss, who is now fighting cancer. He had cancer as a teenager and the insurance company didn't make him go through any waiting period when he hired on last year.

Hope you're insured soon- I'm sure it would be a welcome benefit.

[elegantlion]

Employer-provided health insurance is not allowed to refuse to cover an employee's immediate family. There may be a waiting period for pre-existing conditions, but they aren't allowed to just refuse to cover them.

 

Whew, that is great.

[Mommyof4ks]

I do not know if they can or not, but we were not denied coverage for any amount of time for pre-existing conditions through BCBS from dh's employer. HR should be able to answer that.

[Unicorn.]

Dh's BC/BS is open enrollment, meaning everything is covered immediately. I don't know if it is always that way, but I would definitely ask if the company is offering OE.

[QueenCat]

Employer-provided health insurance is not allowed to refuse to cover an employee's immediate family. There may be a waiting period for pre-existing conditions, but they aren't allowed to just refuse to cover them.

 

This..... unless the employer is "self-funded" and only uses BCBS for processing. Although, this could have changed with the Affordable Health Act, as dh was in an employer self-funded BCBS but it was years ago. Usually, with a pre-existing condition, if you didn't have continuous coverage, it is only that condition that is not covered for a set time period. For everything else, you should be covered.

[elegantlion]

I don't know- but we have Blue Cross through dh's employer and last year he got a new boss, who is now fighting cancer. He had cancer as a teenager and the insurance company didn't make him go through any waiting period when he hired on last year.

Hope you're insured soon- I'm sure it would be a welcome benefit.

 

Best wishes to your dh's boss. :grouphug:

 

I'm more excited about the dental and vision coverage actually. I only get high BP when I visit a regular doctor's office, but I'll be happy to have the option.

[QueenCat]

Asking HR is excellent advice because not all BCBS (as well as other insurers) contracts are the same as each company makes their own contract with the insurer.

[elegantlion]

I do not know if they can or not, but we were not denied coverage for any amount of time for pre-existing conditions through BCBS from dh's employer. HR should be able to answer that.

 

 

 

Dh's BC/BS is open enrollment, meaning everything is covered immediately. I don't know if it is always that way, but I would definitely ask if the company is offering OE.

 

Thanks, I'll have him ask HR.

 

This..... unless the employer is "self-funded" and only uses BCBS for processing. Although, this could have changed with the Affordable Health Act, as dh was in an employer self-funded BCBS but it was years ago. Usually, with a pre-existing condition, if you didn't have continuous coverage, it is only that condition that is not covered for a set time period. For everything else, you should be covered.

 

That was my concern. I'll read the paperwork in more detail tomorrow.

[Amy in NH]

We have BCBS, and they stink. They don't even fully cover routine bloodwork. I'm slowly paying off a $400 bill for that.

[QueenCat]

We have BCBS, and they stink. They don't even fully cover routine bloodwork. I'm slowly paying off a $400 bill for that.

 

That will vary with the plan your (or dh's) employer chooses. Routine bloodwork is covered at 100% with our BCBS plan. When we had it with a different employer, it was covered at 80/20.

[elegantlion]

We have BCBS, and they stink. They don't even fully cover routine bloodwork. I'm slowly paying off a $400 bill for that.

 

I really liked our HMO. When I had my cancer tx, I had $5.00 copays and that was it. I saw the bills, sheesh, but didn't have to pay them

 

. Dh had some health issues this year, it cost us almost 1000.00 to walk into the ER on a holiday weekend. At least some coverage will be better than none, but I detest going for anything routine.

[KungFuPanda]

We went through this. The family was covered immediately, but my son with muscular dystrophy wasn't covered for a year. His regular well-child check-ups were covered, but the Muscular Dystrophy related health costs weren't until the time was up. A law was recently passed to cut down the wait time, but it went through too late to help us so I never looked up the details.

[plansrme]

My dh started a new job today (yea!). He's been self-employed for years and we are currently uninsured. The employer offers blue cross, but I wonder if they can turn down a spouse of an employee due to pre-existing conditions. Or would that simply not be covered for a 12 months (or some mandated period).

 

I had cancer about 17 years ago (we had insurance at the time). Would they deny coverage long term complications arising from the condition? I have a few issues, one that is definitely from one of my surgeries(scar tissue), the others could possibly be blamed on radiation tx. They haven't been enough to see a doctor yet, but could become issues down the road.

 

 

I am an employee benefits attorney and want to assure you of a couple of things:

1. Almost everything that has been posted above is incorrect.

 

2. You are still almost certainly in the clear. If the plan covers spouses (it is absolutely not required to do so) and your husband enrolls during the first opportunity that he has to do so, nothing for which you were last treated more than six months ago can be considered a pre-existing condition. In other words, if the last treatment was more than six months ago, you do not have a PEC.

 

3. Even if you have been treated within the last six months, the maximum PEC exclusion period a plan can impose is twelve months if you enroll at your first opportunity. This maximum is reduced if you have coverage before you enroll. Since you are currently uninsured, I will assume this will not apply to you, but if you have been uninsured for fewer than 63 days, let me know, and we can address the application of your previous coverage to reduce the PEC period. There are a couple of conditions (pregnancy, for one) that cannot be considered PECs, and a couple of exceptions, none of which is likely to apply from what you have posted.

 

4. These rules apply under HIPAA, which applies regardless of whether the employer's plan is fully-insured or self-insured, and regardless of what state you are in. A state may impose harsher rules on the plan, and those would apply only to insured plans, but HIPAA's guarantees are the minimum that would apply.

 

5. Most plans, even when they can, do not impose PECs any more for individuals who enroll when they are first eligible to do so.

 

6. These rules apply to all group health plans.

 

7. You cannot be denied enrollment on account of a PEC or any other health condition though, as noted above, the plan is not required to cover spouses or dependents.

 

Here is a decent summary from the U.S. Deparment of Labor about HIPAA's PEC rules: http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

 

Hope that helps.

 

Terri

[plansrme]

We have BCBS, and they stink. They don't even fully cover routine bloodwork. I'm slowly paying off a $400 bill for that.

 

There are roughly 49,000 BCBS plans in the country. Possibly that is a slight exaggeration, but each BCBS organization, and it is a different one (at least one) in each state, offers many, many plans. You may not like the coinsurance provisions of your particular BCBS plan, but that hardly means that all BC plans would be equally distasteful to you.

 

Terri

[Samiam]

No one here can answer exact questions about your DH's policy.

 

Each company goes to BCBS and gets their own policy/contract written. What is covered and what is not covered is all worked out with the business and BCBS during the time the policy is created. Alot has to do with the cost. For each "feature" that the policy offers employees of the company, the company pays for that, as do you, in your insurance fees.

 

It's like you and I walking into a Honda dealer, both of us wanting to get a minivan. We'll probably pay different prices, get different packages, different features, etc. Just cuz we both drive away in a Honda Oddessy, doesn't mean they are exactly the same, or that we have the same car payment.

 

For someone here to say that BCBS doesn't cover blood work, or had this rule or that rule, that was THEIR BCBS policy and has nothing that you should take as fact about YOUR policy. Human Resources is your best option at this point.

[elegantlion]

Thank you, everyone, and thank you, Terri, I'll check out that link.

[J-rap]

My understanding is that you only have to list things within the past 10 years anyway. So if it has been 17, you wouldn't even have to list it.

[tex-mex]

When I lost COBRA coverage and had no insurance for our rare liver disease -- we signed onto the TX High Risk Insurance Pool. Paid like $330 per person per month. But it was Blue Cross/Blue Shield and very good coverage, imo. No refusal for expensive daily meds and specialist visits. HTH

[angel marie]

when we went on blue cross, we were covered for all our stuff. i didn't have to wait 12 months or get denied for anything. call them tomorrow through your state blue cross.

[Pamela H in Texas]

Okay, so insurance is so different from one plan to another that I can't tell you anything for sure.

 

But a few things (I think for sure):

 

**you can't be denied coverage on hubby's insurance from work regardless.

**if you haven't been actively treated for something in the last ____ months (like 6, maybe 12?), then it would still be covered, not count against you as pre-existing

**if you were treated but had insurance during that time, it also is covered, not counted against you as pre-existing.

 

We were never asked ANYTHING about health issues upfront nor even about treatment issues after the fact so the above wasn't even a consideration at all. It was a specific concern that just didn't play out.

 

Of course, when in doubt, ask :) I would call HR and ask questions. If they don't know, they can probably find out for you or give you contact information so you can find out.

[nono]

Yeah, as said, it's your employer who has chosen the stinky coverage. We have BCBS and it's one of the better plans we have had.

 

Yes, and we currently have individual BC coverage (husband is unemployed). It's amazing to me what is covered in the basic plan. It was a very pleasant surprise. Way better for us than accepting COBRA.

[LizzyBee]

My dh started a new job today (yea!). He's been self-employed for years and we are currently uninsured. The employer offers blue cross, but I wonder if they can turn down a spouse of an employee due to pre-existing conditions. Or would that simply not be covered for a 12 months (or some mandated period).

 

I had cancer about 17 years ago (we had insurance at the time). Would they deny coverage long term complications arising from the condition? I have a few issues, one that is definitely from one of my surgeries(scar tissue), the others could possibly be blamed on radiation tx. They haven't been enough to see a doctor yet, but could become issues down the road.

 

I don't see how they can deny coverage if you haven't seen a doctor or had the issues diagnosed yet, esp with your cancer occurring so long ago. I wouldn't mention them to anyone at the company since that will just give them grounds to deny coverage. After your insurance kicks in, I'd wait a few months to see the doctor about these issues unless they worsened.

Edited November 1, 2011 by LizzyBee

[SweetMissMagnolia]

yeah....I think there could be a "waiting period" where something might not be covered but doubt they could fully deny you coverage....

[Pamela H in Texas]

Just wanted to say that we also have BCBS and everyone we talk to says what good coverage we have. This has been more said about mental health coverage, for my hearing aids, etc. Now, I know we don't have the best in terms of fertility treatment, but it is better than nothing. Our deductible is low. We pay 10% on anything they don't pay 100% of. I can't complain in the least. I'm glad we have it, especially as we add three special needs children to our family (Our ins will be primary).

[elegantlion]

I don't see how they can deny coverage if you haven't seen a doctor or had the issues diagnosed yet, esp with your cancer occurring so long ago. I wouldn't mention them to anyone at the company since that will just give them grounds to deny coverage. After your insurance kicks in, I'd wait a few months to see the doctor about these issues unless they worsened.

 

I have scar tissue in my abdomen, directly related to surgery required during my tx. It's not unlikely that at some point I'll have to have further surgery to remove the scar tissue. I just wouldn't want them to deny coverage for the surgery because it was related to my cancer tx. Logically I understand they wouldn't, but with all the horror stories you here about being denied coverage I thought I'd ask.

 

Nothing is really yet an issue, so I'd rather not call up HR on day 2 of dh's employment.

Edited November 1, 2011 by elegantlion