AboutLinda Woolsteen Expertise I can help you with questions about health insurance. If you feel your insurance company is mistreating you. Are they telling you they are checking eligibity, pre-existing, etc. Or you just don`t understand how your insurance works or don`t understand what a PPO is.. I can help you.
Experience
Past/Present clients One company I worked for I was the underwriter for the Academy of Medicine of Cleveland and the Ohio Bar Association. I was also a supervisor of our customer service department.
Expert: Linda Woolsteen Date: 7/6/2008 Subject: health insurance-open enrollment -texas
Question Myself and my husband are soon migrating to become permanent residents of Texas as beneficiary of I-130 filed by our daughter who is a USC.
I am 54 years and have a pre existing condition (diabetese- controlled ), otherwise in good health, while my husband is (61)in good health.
I understand that it is dificult to get health coverage in US with a PEC history.
I am told that there is an open enrollment period where all applicants with even PEC should be accepted. Is it true? when is that period in Dallas- Texas? Should we time our immigration as landed immigrant just before that open enrollment period? Also, would there still be a wait period applied ?
Kindly note that currently, we have a full comprehensive insurance coverage from a local Insurance company through my husband's employer in United Arab Emirates for last few years , would that help? This insurance covers me fully after I pay for doctor's visit and upto a year maximum, as per the policy.
we also have an option to continue working abroad after getting the Green card for a couple of years so that we get continue to get our health coverage in UAE, and at the same time during these next 2 years, we will pay US taxes and will also pay social security tax on some self employed income which both myself and my husband currently have in UAE. In this case, on getting the Green card, while we work in UAE for next 2 years, we would still like to enroll into some Texas health insurance company and although we will not use the medical facilities there for these 2 years, as we will continue with our coverage in UAE parallelly, but will this help us to consume the Wait Period in USA, if any. So that when we physically move to US after that 2 years period, then at that time we become covered without any further wait period. Do you have any other solution. Kindly guide us.
Answer Hi, so sorry for the delay. We had the 4th of July Holiday and then I had someone harrassing me from this Allexperts site. Anyways, I believe it is a requirement that ALL Insurance Companies offer open enrollement once a year. They publicize their open enrollement in the newspaper. Open Enrollement is meant to allow unhealthy people to apply and be accepted. However, just as the states mandate the insurance companies to do something, they find another way to avoid the ultimate outcome. You see, usually the people that apply during Open enrollement are not healthy & technically if the insurance company has unhealthy people that they are paying out a lot of money in claims, they will go out of business. Therefore, the premiums are usually outrageous for those that apply during open enrollement & most cannot afford to pay what they are asked to pay.
There are two things. Eligibility and Pre-Existing. When you apply with an Insurance Company you have to prove eligibility by answering the health questionairre and usually having medical records requested & reviewed. Then the Insurance Company can do several things: 1) accept you with regular premiums. 2) accept you and rate you up which means they will give you the insurance coverage but will make you pay a higher rate 3) Issue the coverage to you with Rider(s). So, say you have a hiatel hernia, you will have coverage on everything else EXCEPT the Hiatel hernia if they place a rider on that condition. or 4) they can deny you alltogether for coverage.
Then, once you are issued the coverage, if you are, even with Riders or being rated up, Most policies have a Pre-Existing Time period. Some are like 12/24 which would means if you were seen, treated or consulted for a condition 12 months prior to your Effective date, you would then have to go 24 months in the plan, before that condition would be covered.
Usually, in groups of 50 or more, which would be large employers, you are not Underwritten when you apply for coverage (Underwritten means to prove eligibility).
