I have a close friend who's diabetic. She had health coverage through her previous job but her new one doesn't offer it and instead makes a monthly contribution for employees to get their own. One small problem: she has been denied coverage because of a 'preexisting' health condition. She tried to get coverage through her husband's job (he's a dentist) but she's been turned down there as well. I have very little knowledge about the health insurance industry and was wondering if anyone knows why this is the case and, more importantly, how can she go about getting the coverage she needs despite the fact that she's diabetic and dependent on medication to keep it under control. TIA...
Not going to say its impossible, but she'll have a hard time finding individual coverage with diabetes. I have Type II and never could find anyone to insure me when I worked for myself. A few offered to write me but wanted to list my diabetes as an exemption, which would have done nothing for me. With medication and regular checkups, carriers are looking at paying thousands a year for policy holders with diabetes. They would lose money on every individual policy they wrote. That's why they won't insure. She needs to work for a company that has an HMO. They can't deny her coverage then, and best of all, they can't make her premiums any more than the average worker for her company. PPO's can.
Only way to get coverage is if she worked for a HUGE company... ConocoPhillips/Cheveron/ExxonMobil lol (yes I know its big oil ) but they take care of their employees.
I'm a licensed L&H agent in North Carolina; the point there is that some matter of state law may prevail. I reckon you're in Texas... We have a guaranteed issue product in this state but the premium can be up to 7 times (yes 7 times) the standard rate. If she can get an HSA plan issued that would rider out diabetes (although the rider would be no-doubt broad), she could keep her premium down and pile money into her HSA for future expenses that would at least be with tax-free dollars. Maybe she could bring pressure on the new company to offer a group HSA plan. That would offer her group underwriting (fewer or no health questions) and it would allow the company to limit their out of pocket exposure-- which is their goal. Her husband could try the same thing with his dental office. It sounds like he has some individual coverage through one of his dental associations. If her only option is a guaranteed issue plan, he may be able to cover a small office for less than it would cost to cover her. Certainly if he went with an HSA plan that would be likely. My brother in law did that. He had 6 or 7 older employees. Their renewal rates were killing them. They went to a group HSA plan. It keeps his premium lower and the company makes HSA contributions into the employee-owned HSA accounts. He controls his out of pocket costs better and the employees enjoy the HSA dollars which are theirs to keep into retirement if they don't spend them on healthcare. Make sure she makes her COBRA payments if she's eligible with her old employer so that she keeps up continuous coverage from plan to plan. Otherwise she may face waiting periods on even new group coverage for coverage to be effective on her diabetes.
It isn't true that PPO's can deny her and HMO's can't. Texas is a guarantee issue state on group health insurance. We can rate up to 66% (not exactly but close enough) on a group case, but they cannot rate up on an individual. Question, why was she denied coverage through her husband's company? If you are in Texas that is illegal. I'm a licensed insurance broker and can help you with this if you want. Basically, when you lose coverage in the state of Texas that creates a qualifying event. That would in theory mean her husband's job has to allow her to come onto the plan within 30 days of losing coverage whether they want to or not. If they are telling her husband she can't come onto the plan they are breaking the law.
It's not that bad. Big oil would do the trick, but there are many companies that would provide the necessary health benefits. She needs to find such a company and work for them. And never consider a company that doesn't have a good plan.
You don't have to work for a huge company. Plenty of small businesses provide health insurance and if they provide it to their employees, they HAVE to provide it to you even if you have diabetes, aids, etc. Even if she can't get a policy to cover her diabetes, she may want to get a temporary policy to avoid a lapse in coverage. That's when pre-ex comes into play.
I actually just found a new coverage in Texas for people with Diabetes. It isn't as good as a comprehensive major medical plan, but does offer coverage up to 2 million dollars. email me if you'd like more info. texanfanrocket@yahoo.com
Just researched this a lot more today. Basically I found a 64 yr. old who was about to pay over $1,200 a month for coverage, so my being able to offer a policy under $800 was just fine with him. It isn't cheap, but will definitely cover diabetics. At least those taking oral meds. Injections we're still checking on. About the only thing it maxes out on is Chemo. That has a $25,000 limit. Everything else depends on whether the applicant wants copays, and how high they want their deductible, but the out-of-pocket max is at most $10,000. Basically you can get a deductible of 1,000, 2500, or 5,000. After that it is 80/20 coverage with a stop-loss of 5,000. Then it is full coverage per sickness or accident anywhere from $100,000 - 1,000,000, with a lifetime max of 2 million. Rates differ, obviously, but as examples: For the million dollar cov'g/per incident, with a $1,000 deductible, and a $15 copay: 30 yr. old male non-smoker is $292 Smoker is $349 Female non-smoker is $381 smoker is $463 For the $100,000 cov'g/per incident, with a $5,000 deductible, with no copay: 30 yr. old male non-smoker is $86 smoker is $109 Female non-smoker is $121 smoker is $155 And the rates differentiate between those two quotes depending on how comprehensive you'd like your coverage to be.
I guess HIPAA doesn't apply here because this isn't a change to a group health plan? Regardless, your friend ought to have received a HIPAA cert from her prior employer, and if group coverage is regained in like 63 days or something, it is still considered continuous. Not a bad document to have if still within the window I think. I don't have the HIPAA regs memorized, so feel free to search for more if it helps. This is probably a decent starting point frmo the DoL: http://www.dol.gov/dol/topic/health-plans/portability.htm
Thanks for all the info, FFB. I will forward your post/information to her if that's alright with you. I will tell her to get in touch if she wants to. And thanks to everyone else for your replies, I am forwarding everything to her so she can see what her options are.
Just realize I gave the least expensive, and the most expensive with those rates. I always try to fluctuate costs to match what a person is specifically looking for. For example, my buddy asked me to come over and set him up. All he wanted was prescription stuff, but I made damn well aware of not having any coverage. I've heard too many nightmares. So I got him the right coverage he was looking for for what he was looking to pay. Ultimately boys, if you can get max health cov'g in emergency situations for the price of a cable bill, do it. I don't even care who it is with. EDIT: But make sure it is a major medical policy. I've heard way too many nightmare stories about "Megalife", "United American", "Midwest", and NASE". I also stopped dealing with Unicare, but at least they are major medical. They're just not known for their service.
Thanks, Fatty. I e-mailed her your phone# and I hope she does get in touch with you soon, you seem to know your sh!! and she seems pretty lost; that's a good combo.
