AboutGeorge J. Zacherl Expertise I am the Managing Partner of Colao & Zacherl Insurance Group. We specialize in Health, Life, Disability, and Supplemental Insurance policies for both groups and individuals. We are an independent agency representing several different carriers so that we can offer the widest variety of options for our clients.
Experience Licensed Agent in Pennsylvania and Ohio
Expert: George J. Zacherl Date: 6/18/2008 Subject: Insurance Change due to company buyout...while pregnant
Question I have medical insurance through my husband's company, which is in the process of being bought out. I am almost 9 months pregnant, and our new insurance will take effect July 1...which is 3 weeks before my due date. On top of that, the new insurance is no where near as good as what he had previously. The deductible will change from $250 to $750 and out-of-pocket (which we have almost met) changes from $1000 to $2250. It would be one thing if we had time to prepare for the added expense, but we just found out this month (June) that they were being bought out and the new company is forcing the immediate change in insurance - in fact, we have to enroll today. (If they changed the insurance in August it would not even be an issue for us.) Are they obligated to cover the pregnancy/delivery? What are our rights - and the rights of the insurance company - in this situation?
Answer Hi Dodie,
First of all congrats on the new arrival and my best wishes for a healthy delivery for both of you.
This is something I deal with a couple times a year when ladies are having a baby and the insurance plan changes. As for your question about your rights. You have the right to the coverage but the company has the right to pick the plan. And you will still have coverage for the pregnancy and the delivery but at the higher deductible.
I would also contact your doctor and explain the change in your coverage. My youngest is 12 so it has been awhile for me but if I remember correctly most of the test should be done by now. But ask your doctor to complete as many of the remaining tests by July 1.
Lastly, contact the HR person at your husband's company and hopefully they have put is in place already. Ask them if they have setup a Flexible Spending Account. This will allow you to pay for the out of pocket expenses with pre-tax dollars. But more importantly you can submit the bill to the FSA company. They will pay it. You just have to agree to a payment being deducted from your husband's pay over the next year to pay it back. This is something as a broker I would have suggested to the company to help offset the higher out of pocket expenses. It is the best interest free loan you can get.
