Hi all,

I know a few of you work in the insurance business.

I have a question, how does the pre-existing condition limitation work when changing jobs/companies?

A good friend has long been diagnosed with kidney issues and has been on/off dialysis for a few years. She now has a chance to change jobs and work for a different company but is concerned about her health care (new company has better insurance coverage). Any issues with pre-existing conditions or has that been pretty much eliminated due to the wonderful world of layoffs over the past dozen years? Any input would be greatly appreciated.

Thanks,
Greg

Hi Greg -

Very good question...because I'm considering changing jobs very soon - companies, I should say - not jobs.

Anyway, from what I'm told, and I'm no insurance expert - with work related, there are no pre-existing conditions?!?!?!  I could be totally wrong here - and it may just be when changing insurance providers with the same company.  But, when I do change - I'm going to negotiate medical benefits from day one...many compaines have a 60-90 day waiting period.

Lore, would love to get some input from you!

-Shari

Shari:

I believe it depends on the employer.  I have changed companies, and the new company have a clause for pre-existing conditions.  I've changed companies where pre-existing conditions are not an issue with the new company.  Most companies have some waiting period, where some are 1st of the next month after hire, and others are 60-90 day as you said.  Our workplace is 1st day in the month where you have worked 90 days.  Ultimately, it's the employer's discretion (not by employee, which I think would be against the ADA - American Disabilities Act but by the employee population as a whole).  Meaning, the employer can make that a requirement of any employee hired.  This has been my understanding but it may have changed in the last few years with the new HIPAA laws??

Lore, would like ur 2 cents on this too!

Trina

Hi Greg,

Generally, group health insurance is guranteed due to HIPAA - the Health Insurance Portability and Accountability Act. Usually, pre-existing conditions are covered if the employee had coverage in the previous 90 days. HOWEVER, there can be strings attached. There can be a "look back period" if the applicant received advice or treatment for a condition during the six months immediately before enrolling in the health plan. Also called an "exclusion period".  It really depends on the employer. BE SURE AND CHECK IT OUT. Pre-existing condition waiting periods can be 12 to 18 months.

HMO's usually don't apply a pre-existing condition exclusion. Even if the HMO has an "affiliation period" it is usually only 2 months. Still your friend needs to check this out if the company offers an HMO.

Probably the best thing is for your friend to go to the company's website and look at the SPD - Summary Plan Document -which spells out the pre-existing condition limitation if one applies. Also, it will address any waiting period under the eligibility section like Trina mentioned - the first of the month or the first of the following month etc. from the date of hire.

You may also want to have your friend check with her state department of insurance.

Hope this helps.

Hugs,

Lore

Always great advice....thanks Lore!

-Shari

 Lore....

[smiley=bow.gif]

Thank you for the info....I just cut and pasted your info into an e-mail. This is great information to know, especially with all of the corporate lay-offs lately.

Thanks again,
Greg

Greg,

Just another thought that came to mind............if your friend really wants to change jobs and the company has a pre-existing clause, she can elect COBRA to cover her through the waiting period. COBRA can be very expensive as one will pay the actual premium the company pays. However, COBRA is cheaper than being faced with hundreds of thousands of dollars should something catastrophic occur. I don't recall the actual time limitation for electing COBRA coverage, meaning she may not need to elect it right away. She can keep it in her back pocket, so to speak, in case she would need it.

Hugs,

Lore

Lore:

I believe most COBRA plans give you 60 days to sign up from receipt of your COBRA letter.  Technically, you can go to providers from your old plan as if you are still under the plan and get paid for those services later even if you don't sign up until later.  That's risky of course, but it's been done.  Also, you are right, you pay the full premium but the employer can also charge an additional 2% admin fee for processing COBRA on your behalf.  So keep that in mind.  

Trina