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You are here: Experts > Industry > Health Plan > Health Plan Administration > quesiton about coverage and short term plan
Expert: Linda Woolsteen - 10/24/2009
Question
QUESTION: My husbands employer went backrupt in July 09. He lost his job. We believe his insurance through medical mutual ended as of July 31, 2009.
He picked up short term insurance through blue cross anthem which took affect immediatly. He was unaware that he could buy it for 6 months so he paid for two separate policies for each month (Aug and Sep) each month we got a new set of cards. Not sure if that matters but wanted to mention.
He got reemployed and his new group health benefit plan through anthem blue cross blue shield went into effect October 1, 2009.
My question to you is, my husband and I are having a debate. He says as long as you do not go 60 days without health insurance, when you get a new plan you do not have to worry about preexisting condition coverage. He claims that even though he got a cheap short term plan, we are considered consistantly covered.
I debated that I don't think short term is anything and that we are really on the "brink" of the time line of 60 days and that the short term does nothing for us on this 60 day thing.
Anyhow hope i am making sense. So main question does short term mean we had coverage over these 60 days or is it nothing?
ANSWER: Hi,
When you go from one plan to another, you want to obtain your CCC (Certificate of Creditable Coverage) from the prior insurance carrier or carriers if there is more than one... get a CCC from each of them and give it or them to the new Insurance Carrier.
The time period is 63 days. If the rules have not changed, the new Insurance Company does not have to accept CCC's from Individual Plans thus the reason most people try to pay and continue under COBRA.
Since the individual policies he bought were through Anthem and his new Employer uses Anthem... I would think that Anthem will give him continous credit for any Pre-existing conditions and not hassel him. The company I use to work for would not accept CCC's from Individual plans but like I said maybe it has changed and/or Anthem will not mind since he bought his individual plans from them as well and now has them again.
Don't be surprised if you have to still get your CCC's from them and then present them to them in a different department at the same company instead of them just being able to review it internally.
I had a hard time with MMO (Medical Mutual) over that same thing. My fiance' had MMO with his old employer then we took out an individual MMO policy for him and I had to submit the CCC which was from them for the old policy to review for credit under his new policy with them.
I think they will be ok with him and not ding him but you really, really have to watch when you are inbetween jobs and take out individual policies. If you can afford it you are better off continuing under COBRA if you can. If you read back in one of my answers to someone else, I told them about a story I read in a magazine (I think it was TIME) about an awful tim a man had when he took out an individual policy when he was inbetween jobs and I believe he did just what your husband did, bought a new one the next month and then he had kidney problems or something and they would not pay for his dialysis or something like that... it was a big mess. Poor guy.
If they try to give him a hard time at all because it was an individual policy. You can always Appeal by sending in a letter stating on it "APPEAL" and advise the individual policies taken out were with them and ask them to consider that.
---------- FOLLOW-UP ----------
QUESTION: Linda thank you so much for your time and explanation. I think I partially understand it. I am not an insurance person at all so many loop holes.
So what I seem to get is that short term insurance really does not protect you from the 63 day time lapse? It really does not count?
Thanks Linda for taking the time to respond I really appreciate it. Have a great weekend.
Answer
Hi,
All I know is that the company I worked for would not accept a CCC from an Individual Policy for credit toward the PE time period.
In my 25 yrs working with insurance companies I often asked questions concerning individual policies, even from the Department of Insurance and never really get a clear cut answer from anyone.
A lot of things vary from Insurance Company to Insurance Company and comes down to the Companies own policy.
I just searched and researched as much as I could on Anthem, HIPAA, CCC's for the last few hours. I think this is the best page I have found:
http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html
It is from the United States Department of Labor Web page. Read this section: Can I reduce or eliminate the maximum preexisting condition exclusion period?
It says Certificates of Creditable Coverage from Individual plans are even acceptable. I don't think you should have any problems.
You do know that Eligibility and Pre-Existing are two seperate issues. You first have to be eligible for the policy to get the coverage and then once you are made effective the Pre-Existing time period/Certificate of Coverage comes into play.
Usually, if it is a group with at least 20 or more employees you do not have to prove insurability but if it is a small group you usually have to prove insurability and then based upon your health they can either accept you, deny you, give you the coverage with rated up premium, or give you the coverage with riders on certain conditions or both rated up premium as well as riders. A lot of times people do not understand there is a difference between the two. Hopefully, he is going into a large group.
Hope I have been of some help.
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