Pre existing Conditions and Marriage

[goodlife]

What is the name of your state (only U.S. law)? New York State

Hi,

I live and work in New York State. I have worked for the same company for 6 years and receive health insurance through them. I have no health problems and take no medication.

My girlfriend of two years was diagnosed with heart failure in October 2007. She went on to get a pacemaker/defibrillator implanted in her chest in January 2008. She is receiving social security disability and currently has health insurance through COBRA since she had to leave her job due to the heart condition. She is currently on multiple medications.

We are about to get married. I have the ability to add my spouse to my insurance plan provided to me through my company. The form asks if if my wife to be is currently disabled, actively employed and her prior health insurance carrier. There are no questions about any pre-existing conditions.

I am worried that my spouse can be denied coverage due to her heart condition. What are our rights? I want to prepare for the worst.

Thank You!

[cbg]

If you are talking about a group health insurance plan sponsored by your employer, the insurer cannot and will not deny her entry to the insurance plan as long as you add her within 30 days after the date of your marriage. Depending on how the policy is written and when your fiancee last had medical treatment for her condition she might be subject to a pre-existing rider for her heart condition only. Please note that under the law, in the circumstances you describe, as long as you add her within 30 days of the marriage the longest that such a rider could be in effect would be 12 months and it could be considerably shorter, or not at all.

[goodlife]

Thank you for your reply.

Yes, this is a group health insurance plan sponsored by my employer. Her last procedure was in January 2008 when the pacemaker/defibrillator was implanted. Following that she just has to do standard follow-ups with her physician every four months.

[ecmst12]

And if you can make sure there is no gap in coverage between her Cobra and your plan, or a gap of 63 days or less, then no pre-existing limitation can be applied at all.

[goodlife]

There will be no gap whatsoever.

So in order to ensure that we will always be "safe" I need to ensure that there will be no gap in case I switch insurance. Are there some simple guidelines or pointers to follow in order to always stay in the clear so I never have to find myself and my wife without coverage?

Thank you all for your input.

[ecmst12]

Just make sure you add her within 30 days of your wedding. No exceptions, if you miss this window, you will have to wait for open enrollment to add her.