vollentary termination group ins. to individual ins.

[tetro]

What is the name of your state? california: current situation is im employed for 7.5 years with a major car company with thousands of employees. i have had the same health ins. for all 7.5 years and for 4 years prior employer . health ins is pacific care hmo.

i am a single male parent, with 3 children. myself and two children ages 16 and 10 are in good health. my other child 14 is severly disabled and has many preexsisting conditions, cebral palsy, hydrocephalus, short bowel syndrome, has had 20 plus surgeries, ect. .

i want to vollentarly terminate my employment with group health plan and go to individule health plan. so i can stay home to take care of my son.

my employer says im eligible for cobra 18-36 months and also some kind of hippa or contiuation coverage. pacific care says in their evidence of disclosures and at custumer service im eligible. the california ins, board says im eligible, the goverment of health for cobra says im eligable, and also the department of health ins. that governs the health ins. says im eligble.

my problem is my son needs surgery again soon . the only thing holding me up from doing this is obviously financially i need to be able to do this. my son has an estate watched over by the courts. im asking to be reimbused finacially for my wages lossed after quitting. they are not convinced my son will be eligble for any health coverage. so they wont proceed until i have some kind of more proof. i have given them everything i can from all the above envolved.

and no he is not eligble for ssi or medical because of the money i make and that he has in his estate.


i need answers! please help!



i need answers! help!

 

[Beth3]

Your employer is correct that if you resign, you are eligible to continue your current medical plan through them for 18 months (29 months for your son because he is disabled) by paying the full monthly premium +2% for the first 18 months, then 150% of the full monthly premium for the 11 additional months.

It is an absolute requirement that you and your eligible dependents be offered continuation for this period of time after your employment ceases. The applicable federal law is the Consolidated Omnibus Budget Reconciliation Act (hence, COBRA.)

This COBRA requirement is widely understood as it's something that all employers with 20 or more employees have to comply with. HIPAA standds for the Health Insurance Portability and Accountability Act and prohibits employers/carriers from excluding pre-existing conditions from coverage (or denying coverage) due to a medical condition if there has been no gap in coverage.

I'm not sure what else can be provided to the court overseeing your son's estate that would resolve the issue. These are FEDERAL laws, not some obscure insurance industry regulation.

 

[tetro]

i am totally convinced ! how do i convince them? can anybody talk to my lawyer and the courts and assure them? where can i get help? my son i feel despretly needs my full time attention! my ins. feels they have provided all the necassary info. any suggestions? and what happens after cobra expires? thank you for reassurance!

 

[Beth3]

After COBRA expires, then you will need to get individual insurance for yourself and your son. That's when you will find the requirements under HIPAA very helpful. Coverage can't be denied but you should anticipate that premiums will be calculated based on "anticipated losses" so the coverage (especially for your son) is going to be quite expensive.

Sorry, nobody here can talk to your attorney or the lawyer for you but if you can get a copy of the COBRA notification your employer sends when someone leaves and I expect they can also provide you with information on HIPAA (an internet search also ought to turn up ample information.) If this is YOUR attorney, I guess I don't quite understand why you're having to do all the legwork to prove to him what the federal laws are.

 

[tetro]

very helpful and encouraging info. yes i agree with the lawyer thing! she has all the info i have and still has issues! would get someone else but so much time has expired already. to start over with someone else would probably take even longer! anyways thanks for another confirmation on behalf of my son and i!