Health Insurance

[cougarrich]

My wife has recently been diagnosed with cancer. Prior to this development I was making plans to switch employers. Is my new employer's group health insurance company required to insure us and cover my wife's condition?

 

[cbg]

Assuming that you have been covered under your current health plan for a year or more, that AND assuming that you join the new health plan at your first opportunity so that there is no gap of 62 days or more between the end of the old plan and the beginning of the new plan, yes, they are.

 

[cougarrich]

Thank you for your reply. Is the law behind this published somewhere on line? I would like to read up on this. By the way, I live in New York State.

 

[cbg]

It's a Federal law, abbrieviated HIPAA. I'd have to stop and think what it stands for. Go to your favorite search engine and search on HIPAA. BTW, it's barely possible that NY may haave a shorter look-back period than one year (my state does) but it CANNOT be longer than one year.

If you were covered under the old plan for less than a year, you still have to be covered under the new plan, but your wife's condition CAN (that is not to say that it will) be excluded for the period of one year minus the length of time you had coverage. For example, if you had coverage for eight months, her cancer can be considered a pre-existing condition for four months.

If there is a gap between the old and the new plans of more than 62 days, the new plan can consider the cancer as pre-existing for the full year, no matter how long you had coverage previously. Contractual waiting periods don't count; however, that's also what COBRA is for.

Again, I'd like to reiterate that not all insurance plans have a pre-existing condition clause, and the ones that do are limited to a maximum of 12 months.