HIPAA inflexibility question

[DanC999]

What is the name of your state? Tennessee

My wife and I were on a group insurance plan in Oklahoma, and we relocated to Tennessee where I now work for a small firm. Premiums for me are OK, but for her would have been exorbitant, not to mention the pre-existing waiting period. We are shopping for individual health insurance for my wife, and she does have a pre-existing condition. We will be HIPAA eligible as of 9/1/07, but I heard from some sources (including the state department of insurance) that once we are on a HIPAA (or guaranteed-issue plan) we are locked in indefinitely. Is that true, even if I in the future get her onto group insurance, or if she gets well? I know HIPAA is all about portability, but I thought it would be flexible as well. Thanks for the help.What is the name of your state?

[TIMMAAYY]

No, you are NOT locked into a HIPAA plan. Ever. If you were to get a new job that offered insurance, for you and your spouse, they will have to take you. They may have their own rules for when you can come on the plan ( waiting period), or who they offer coverage for( just you, you and your family, etc. ), but by no means are you locked into a HIPAA plan for life.

In fact, most carriers would be glad to get you off their HIPAA plans, as would the state plans for those states that have them ( ie Indiana, Kentucky, etc. )

Depending on the individual insurance you are trying for, keep in mind that not all of them underwrite in the same manner. That is, one carrier may take your wife, but simply rate up the premium. Another carrier may take her, but not cover the pre existing condition by ridering it off the policy. Yet another might not take her at all. If you are anywhere near Memphis, I have a contact down there who can help you out.

If they do decide to take her, and they cover the condition, they won't be able to pre x it out if you have had continuous coverage for at least 12 months and no gap more than 63 days. You will usualy see this on the policy offer... a credit for prior coverage in terms of time. They can, however, still rider it out completely.

As far as the DOI's are concerned... don't get me started. Most of those that work there are apparently not bright enough to work at the DMV.

[DanC999]

An update on this, and a couple more questions: some companies have already turned her down for an individual policy. (even though we are HIPAA eligible, it was an "exclusion"). So be it. However, I have looked at the Department of Labor HIPAA non-discrimination requirements and find that she cannot be turned down because of health factors, and it lists them, etc. Does this non-discrimination only apply to group plans? I know that group insurance is miles better than individual insurance because of risk, and therefore premiums. But it still seems like a shaggy dog to me. Which leads to the next question.

I am now investigating getting her on my group plan at the office, and everything I see (except the insurance people) says that this is allowable and for the best; but it raises the question: since we are HIPAA eligible, why can't she just get on to the group health plan directly? Several people (again, from the DOI, who may or may not be believed) have stated that she has to be on a "HIPAA Plan", implying individual policy. But if she's HIPAA eligible, I thought the whole idea is that this is portable, and she could join a group plan!! I believe we can. Could someone shed some light on this? Thanks, D

[ecmst12]

You can only add her on to your employer's plan during open enrollment or within 30 days of a "qualifying event". So adding her onto your plan right now may not be an option.