Health Insurance – What You Should Know

This will be one of many upcoming posts about health insurance benefits given the state of the S.S. Heller Ehrman.  Also, since we aren’t encouraged by a recent comment about one of Heller’s providers, CIGNA, we feel you need these links and information:

1.  COBRA

Realise that until we hear definitively from Heller management, COBRA is not a guarantee.  COBRA stands for the Consolidated Ombinus Budget Reconciliation Act 1985 and sets out rules as to the continuation of health insurance coverage after leaving a position.  

2.  Individual Coverage

You want to investigate individual coverage through your insurance broker (your insurance agent for life or homeowners most likely can hook you up with Blue Cross/Blue Shield or a similar product and he or she can make a litte money off the referral).

Keep in mind, however, that if you have an existing condition, most likely your application will be denied entirely.

3.  State Funded Comprehensive Healthcare Insurance Program

Most states provide healthcare insurance programs for individuals who have been denied coverage.  Below is a list of links to the program for each state.  Be warned that the cost is not cheap.

Alaska – https://www.achia.com/Default.asp 
ACHIA offers coverage to individuals who are unable to purchase an individual health insurance policy because they have pre-existing health conditions. If you have been diagnosed with one of the health conditions listed on the ACHIA website, you are automatically eligible for ACHIA coverage – you do not need to apply and be rejected by an individual insurer first.

ACHIA also offer coverage to “HIPAA-eligible” individuals. This refers to people who have left job-based group coverage AND have elected and fully exhausted any COBRA or state-operated continuation coverage they were offered. ACHIA is intended to provide a permanent coverage option for people who are unable to find insurance after leaving their job and using all of the temporary coverage they have available to them.

California – http://www.mrmib.ca.gov/
The California Major Risk Medical Insurance Program offers coverage to individuals who have been rejected for individual policies because of preexisting health conditions. For more details on MRMIP eligibility requirements, contact MRMIP by phone or download a .pdf version of their brochure here. The brochure also includes information on premium rates and coverage. MRMIP coverage is limited to 36 months ONLY – however, once you have exhausted your MRMIP eligibility, you will be guaranteed the right to buy a policy in the individual market.

California Major Risk Medical Insurance Program
P.O. Box 2769
Sacramento, CA 95812-2769
Phone: 800-289-6574 OR 916-324-4695

Connecticut – http://www.hract.org/hra/index.htm
The Connecticut Health Reinsurance Association (HRA) offers coverage to individuals who have been rejected for individual policies because of preexisting health conditions. HRA also covers “HIPAA eligible individuals” who have left group health coverage AND fully exhausted all COBRA or state continuation coverage for which they are eligible. For more details on HRA eligibility requirements, contact the HRA by phone or visit their website.

Connecticut Health Reinsurance Association
100 Great Meadow Road, Suite 704
Wethersfield, CT 06109
Phone: 1.800.842.0004
http://www.hract.org/hra/index.htm

District of Columbia – http://www.carefirst.com/main/html/HomePage.html
All District of Columbia residents are entitled to purchase an individual health insurance policy through Carefirst Blue Cross Blue Shield. If you are rejected due to a pre-existing condition, be sure to ask for a “guaranteed issue” policy. 

Illinois – http://www.chip.state.il.us/
ICHIP offers coverage to individuals who are unable to purchase an individual health insurance policy because they have pre-existing health conditions. It also covers “HIPAA-eligible” individuals as described above. The ICHIP website allows you to apply for coverage online, or to download forms and brochures containing more information about the program.

Illinois Comprehensive Health Insurance Plan
320 West Washington Street, Suite 700
Springfield, Illinois 62701-1150
Phone: 866-851-2751 (toll free in Illinois) or 217-782-6333

Maryland – http://www.marylandhealthinsuranceplan.state.md.us/
MHIP offers coverage to individuals who are unable to purchase an individual health insurance policy because they have pre-existing health conditions. It also covers “HIPAA-eligible” individuals as described above. The MHIP website has information on their eligibility requirements, current premium rates, and a fact sheet which details the benefits available under their program here.

Maryland Health Insurance Plan
10455 Mill Run Circle
Mail Stop RR-291
Owings Mills, MD 21117-9185
Phone: 443-738-0667 OR 1-888-444-9016

New Jersey – http://www.nj.gov/dobi/ihcpage.htm
New Jersey has a special Individual Health Coverage program which guarantees that people with pre-existing health conditions can obtain health insurance. Those who are interested in buying a policy under the Individual Health Coverage program should read the Buyer’s Guide before contacting IHC program insurers directly for coverage. The Buyer’s Guide contains important information about the program, including eligibility and benefits.

Individual Health Coverage Program
Phone: 609-633-1882
Fax: 609-633-2030
E-mail: ederosa@dobi.state.nj.us

New York – 

Health Plan of New York is one that comes highly recommended from several friends of your Cruise Director, especially for those who are in business for themselves (consultants, working girls, etc.)

Insurers in New York must offer you health coverage regardless of your health status. However, state law does not limit the monthly premium you can be charged for your insurance policy. Also, insurers may impose a pre-existing condition exclusion period of up to twelve months upon those individuals who do not have prior continuous coverage.”HIPAA-eligible” individuals are exempt from these pre-existing condition exclusion periods. You may be HIPAA-eligible if you:

  • had at least 18 months of continuous creditable coverage, the last day of which was under a group plan AND
  • you have exhausted all COBRA continuation coverage which was available to you.

If you are not sure whether you are a HIPAA-eligible individual, your insurance agent or theNew York State Insurance Department can help you find out.

Virginia – 
All insurers in Virginia, except for Anthem Blue Cross Blue Shield and Carefirst Blue Cross Blue Shield, are allowed to reject your application for coverage based on your health status. The Blue Cross Blue Shield companies offer special “guaranteed issue” plans with limited pre-existing exclusion periods.

You may also qualify for coverage as a “HIPAA-eligible” individual if you:

  • had at least 18 months of continuous creditable coverage, the last day of which was under a group plan AND
  • you have exhausted all COBRA continuation coverage which was available to you.

If you are not sure whether you are a HIPAA-eligible individual, your insurance agent or the Virginia Bureau of Insurance can help you find out. 

Washington – https://www.wship.org/
WSHIP offers coverage to individuals who are unable to purchase an individual health insurance policy because they have pre-existing health conditions. It also covers “HIPAA-eligible” individuals. You may qualify for coverage as a “HIPAA-eligible” individual if you:

– had at least 18 months of continuous creditable coverage, the last day of which was under a group plan
AND
– you have exhausted all COBRA continuation coverage available to you

If you are not sure whether you are a HIPAA-eligible individual, your insurance agent or the Washington State Office of the Insurance Commissioner can help you find out. For more information about WSHIP, including premium rates, contact WSHIP.

WSHIP
P.O. Box 1090
Great Bend, KS 67530
Phone: 800-877-5187

Wisconsin – http://www.hirsp.org/
HIRSP offers coverage to individuals who are unable to purchase an individual health insurance policy because they have pre-existing health conditions. It also covers “HIPAA-eligible” individuals, as described above. For more information about the program, including premium rates, contact HIRSP.

HIRSP
Phone: 866-445-8491 or 304-558-8264

4.  Have Your Spouse or Domestic Partner Provide Coverage

It may be best to have your spouse or domestic partner add you to his/her current coverage especially if you have an existing condition.  In most cases, loss of your position at Heller is a “qualifying event” and you will not be excluded due to an existing condition.  Of course, each plan is different, so please review the details contained in your spouse or domestic partner’s plan.

Note for domestic partners:  there are some tax implications involved in having your partner carry you for benefits!  Realise that although it may cost only $100 extra a month for your partner, he or she will be taxed on the actual value of the benefit which may be $300 or $400 or more a month!

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5 Responses to “Health Insurance – What You Should Know”


  1. 1 Donna 29 September 2008 at 8:02 am

    Thank you for all the health insurance info. I really thought I was okay paying the high fees for COBRA since being downsized from Heller in April. I’ll have to look into other less costly alternatives in case my 600 a month somehow goes missing and I’m left holding the bag!

  2. 2 tjk 29 September 2008 at 10:23 am

    The WARN letter says we are receiving salary and benefits until Nov. 28.

  3. 3 hellerdrone 29 September 2008 at 10:30 am

    tjk

    Understood, but what is not addressed is whether or not COBRA will be available to extend the healthcare benefits for the next 18 months as is available to most employees that leave a firm.

    Heller Drone
    Cruise Director

  4. 4 Observer 29 September 2008 at 2:40 pm

    This is an important topic. Management should address it and communicate with everyone about it. COBRA cost is on the individual; the obligation of the insurance company to make it available to you continues as long as the group plan that you are departing from continues in existence. It is my understanding that the firm plan can continue as long as there is at least one group member still around, which may be well over 18 months in the wind down scenario. What I don’t know is is how much it would cost the firm to preserve the group plan with the one minimum member. Perhaps someone can enlighten us.


  1. 1 New York Healthcare - Health Plan of New York « Heller Highwater Trackback on 1 October 2008 at 5:25 am
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