TYPES OF INSURANCE

Group Insurance – this is best and will be the most comprehensive.  Groups under 50 employees can’t be turned down.  Groups over 50 are generally OK as you do not have to complete individual health statements.

Individual Insurance – If you have a plan, keep it.  It is doubtful you will be approved for a new plan or carrier.

Cobra and Cal-Cobra - If coming off group insurance, you can elect Cobra for 18 months at 102% of the cost for an active employee.  In some instances, you can elect Cal-Cobra for an additional 18 months at 110% of the cost for an active employee.  If there is no Cal-Cobra and you are approved for Social Security Disability, you can keep Cobra going for another 11 months but at 213% of the cost for an active employee.  There are better options than the 11 month extension.

When Cobra/Cal-Cobra ends - What to do now?  If you have been continuously covered for at least 18 months and exhausted all Cobra/Cal-Cobra available to you, you will qualify for a HIPAA plan.

HIPAA (Health Insurance Portability and Accountability Act) guarantees coverage in this situation.  You are eligible for at least two plans with any insurance carrier that offers individual insurance.  In California, you can look to Kaiser, Blue Cross, Blue Shield, Aetna, Pacificare, Health Net.  Premiums are high and deductibles are usually high as well.

No connection to group insurance or Cobra, what do to now?

NO INSURANCE – Three options

Mr. MIP - Apply for an individual plan.  You will be rejected.  You are now eligible for Mr. MIP which is the high risk pool in California.  Carriers in that pool for Northern California are Kaiser, Blue Cross, Blue Shield, Contra Costa Health Plan.

These plans are subsidized by the tobacco industry but are still expensive.  They also have a $75,000 maximum benefit per calendar year.  There is sometimes a waiting list to get into this plan and there are pre-existing limitations.  If you select Kaiser, which is the least expensive plan, you can’t join for 3 months from your approval date unless you have ongoing insurance.

Medicare – if you are granted Social Security Disability, you will get Medicare Part A and B after two years.  Make sure to enroll in Part B as it is not automatic.  You should also purchase a supplement to pay expenses Medicare does not cover in full.

Enroll in a Part D plan as soon as you are eligible for Medicare.  Part D is the drug component.  You may need help finding the right plan.  Blue Cross has a good plan for about $35 that covers generic drugs during the “gap” period.  The “gap” period is the period of time when the insurance company does not pay for drugs.  They pay the first $2250 and then not again until you are out of pocket $3600.  If you are very low income, this does not apply and your premium is free.

Medi-Cal – If you have no coverage and are low income, the state may pay for your health expenses.

ADDITIONAL INFORMATION

HIPP – this government agency may pay your Cobra premium for you.  See the wording attached.

Kaiser – Kaiser has a program for people who are enrolled under a group plan and then lose employment.  If your income is low, you may qualify for reduced premium.  Contact member services at 800-464-4000.

What about pre-existing Conditions – If you have maintained continuous coverage you do not need to worry about pre-existing limitations.  Also, most HMO’s do not have pre-existing limitations.  In most instances, a pre-existing condition is defined as a condition diagnosed, treated for, medicated for had testing for in the 6 months prior to the effective date for coverage.  With group insurance, they will cover that condition after 6 months on the plan.