Health Insurance

[newt_k]

What is the name of your state? CA

Married 8 years, wife wants a divorce. I get my health insurance through the business that she owns. Am I covered during a separation? During the six months it takes for a divorce to be finalized? Can she continue to provide health coverage for me after we're divorced, under the company plan?

Also, what constitutes a "preexisting condition?" I have a stable lesion that showed up on a CT scan while getting treatment for an unrelated injury. My doctor wants to keep an eye on it, just in case. His recommendation is "one more scan in 6 months and then another, one year after that." I worry about staying insured and/or getting new insurance during this time.

 

[cbg]

There is no law in any state that dictates that you MUST be covered during the period of separation or the time leading up to the divorce. There is also no law in any state that says you can't be. It's not as cut and dried as that. The law does limit at what time a spouse (regardless of status) can be added to or dropped from the plan, but it has nothing to do with your marital status. It has to do with when open enrollment is. You CAN be dropped during open enrollment. You CANNOT be dropped when it is not open enrollment, until the divorce is final.

The insurance plan document itself will determine whether or not you can continue to be covered after the divorce is final. That is also not dictated by law.

(Before anyone gets onto me about how the divorce decree can require insurance coverage, yes, it can. However, if the plan document does not allow for coverage of a divorced spouse, then to be in compliance with the divorce decree the responsible spouse will simply have to find other coverage. The divorce decree is binding on the spousal parties, not on the insurance carrier. The insurance carrier is not required to cover an otherwise ineligible former dependent.)

A pre-existing condition is one for which you have received treatment during a lookback period. Under Federal law the lookback period is 12 months. State law can make it shorter. I do not know if your state has done so but I will be surprised if they have not.

 

[LdiJ]

What is the name of your state? CA

Married 8 years, wife wants a divorce. I get my health insurance through the business that she owns. Am I covered during a separation? During the six months it takes for a divorce to be finalized? Can she continue to provide health coverage for me after we're divorced, under the company plan?

Also, what constitutes a "preexisting condition?" I have a stable lesion that showed up on a CT scan while getting treatment for an unrelated injury. My doctor wants to keep an eye on it, just in case. His recommendation is "one more scan in 6 months and then another, one year after that." I worry about staying insured and/or getting new insurance during this time.

She not only can, but should be required to continue to provide your coverage until the divorce is final. However, once the divorce is final her employer plan will no longer allow her to continue to provide you coverage. You will however be able to choose to continue coverage under cobra....but you will have to pay for it, and most cobras are expensive.

 

[Bali Hai]

She not only can, but should be required to continue to provide your coverage until the divorce is final. However, once the divorce is final her employer plan will no longer allow her to continue to provide you coverage. You will however be able to choose to continue coverage under cobra....but you will have to pay for it, and most cobras are expensive.

Since you don't know all the details about this divorce, the stbx wife may be ordered by a judge to provide cobra insurance to OP as well as alimony since he has a medical condition that developed during the marriage.

 

[newt_k]

Interesting. I'll have to get a copy of the policy and see what it says.

How does the lookback period work? Does that waiting period mean the new insurer doesn't have to pay for conditions you've been treated for in the last 12 months(or whatever the period is), or does it mean they will cover the existing condition, but only after you've been insured with them for 12 months (or whatever the period is).

Say that first scan happens before the divorce is finalized(six months from now), and I'm covered. What happens after that if I get my own private insurance (or anther group plan), going forward? Would I be covered under my new policy for the next scan (18 months form now) and anything that might come from it?

 

[moburkes]

Pre-existing Condition
Any illness or health condition for which you have received medical advice or treatment during the six months prior to obtaining health insurance. Group healthcare policies cover pre-existing conditions after you have been insured for six months, and individual policies cover pre-existing conditions after you have been insured for one year. Reference CIC Section 10198.7. Creditable coverage must be counted towards any pre-existing condition exclusion in either an individual or group policy.


http://www.insurance.ca.gov/0100-consumers/0070-health-issues/health-insurance-terms.cfm#P

 

[newt_k]

Since you don't know all the details about this divorce, the stbx wife may be ordered by a judge to provide cobra insurance to OP as well as alimony since he has a medical condition that developed during the marriage.

To be clear, I don't have any serious injuries or physical limitations. Doc says the incidental lesions are most likely nothing to worry about. I'd just hate to find out this thing is liver cancer or something at the same time my insurance runs out.

 

[newt_k]

Section 10198.7. Creditable coverage must be counted towards any pre-existing condition exclusion in either an individual or group policy.

I've had my current coverage for 7 years. Does this mean a new insurer would have to take me and provide coverage right away?

Is my insurance going to go through the roof when I switch? I'm not familiar with the laws for setting health insurance rates.

 

[cbg]

A new GROUP insurer would have to accept you, though you would still be required to fulfill any waiting periods that might exist. A waiting period is NOT the same as a lookback period. A waiting period is when you start with a new job and insurance kicks in after 30, or 60, or 90 days. They are not required to waive waiting periods because of creditable coveragel. (Individual insurance plans are often not bound by the laws limiting pre-ex conditions.)

The lookback period I referred to works as follows; when you submit a bill for a potentially pre-existing condition, they will "look back" at the last - by Moburke's link it should be six - months. If you were not treated for that condition during that six months, then the condition will not be considered pre-ex and, assuming that it is covered under the policy, will be paid for under the terms of the insurance contract.

We have no way of knowing what your insurance rates will be. That will have to do with what coverage is provided in relation to the coverage you have now.

 

[newt_k]

Thanks for the clarification. I do freelance work outside of what I do for the business. You say private insurance doesn't have to follow the pre-exist rules. Does that mean I'd have to find a job with health benefits under a group plan, just to stay fully insured?

What if the business takes me on as an employee? Would I be able to keep my coverage that way?

Or, I guess I could take the 36mos of cobra and see where things go from there.

 

[cbg]

Not necessarily. Not all insurance plans even use a pre-existing clause. You'd simply have to do a little research before hand (a good insurance broker can help you with that). Nor does it sound as if what you have is actually going to be considered pre-ex. Don't forget that AT WORST the one condition would be considered pre-existing for a maximum of six months to a year. EVEN IF the insurance you end up with uses a pre-ex clause, your coverage would ONLY be limited for the lesions, ONLY if you'd received TREATMENT for them within six months, and ONLY for a period of six months or a year, depending on the type of insurance (group or individual), after the insurance begins. After that, there would be no pre-ex exclusions at all.

IF the business took you on as an employee AND IF the terms of your employment were such that you qualified for the health insurance, yes, you would be able to keep your current coverage. If your wife owns the business, though, I wouldn't count on that solution coming through for you.

COBRA is always an option.