New job, insurance coverage

shuggy1972 · Regular Joined: 31 Mar 2008 Posts: 28 Location: New York

Hi

Here's my situation.

I arrived in the US (Green Card) on 1st Dec 2007, having living most of my life in the UK where we don't have to deal with this health insurance crap.

On 1st Jan 08 (thank God!) my wife added me to her employer insurance plan (Aetna POS Open Access).

In mid-Feb 08 I started having a number of symptoms which led me to consult a PCP and then various specialists. I am currently seeing a Head & Neck specialist at Memorial Sloan Kettering Cancer Center in NYC. I DO NOT YET have a definitive cancer diagnosis, but am under diagnostic investigations for either lymphoma or thyroid cancer. Looking like the next step for me will be a surgical biopsy of one of the enlarged lymph nodes in my neck.

So far, my wife's insurance has paid for everything without a problem.

Now, I've just received a job offer, and the job comes with health insurance. In fact, the two plans offered are both Aetna, and very similar to the one we currently have through my wife's company.

I think I've worked out that there's not much point having two insurance plans with the same carrier(?), but I'm nervous about this "pre-existing condition" thing in case I do get a cancer diagnosis and need a lot of expensive treatment.

What happens if I switch to the Aetna plan from my new employer? Even though it's the same carrier, do they count it as a 'new' plan and can they therefore refuse to cover me if I'm found to have a pre-existing condition?

Also, how does this 'open enrollment' deal work? Does that mean that if I sign up during the open enrollment (which is Nov) rather than immediately when I start my job (likely to be in mid-Sept) they won't check my medical records? What happens if they subsequently check and find out that I was having diagnostic tests - can they then refuse to pay?

Should my wife change her insurance for us both during her open enrollment period (also Nov) as she has a much wider selection of carriers? Would this give us increased cover, or could it potentially give them an opportunity to exclude me?

I'm really nervous that I'll make the wrong choice, then find out that I've lost coverage just at a time when I need it most. Oh, and we're having a baby at the end of Oct, so we also need to figure out which insurance we can get to cover our new child.

VERY confused by how all this works, although I recognise that by having some coverage at present I'm in a better situation than a lot of people here...

Any advice or info would be most welcome,

thanks

Euan

brainman · Posted: Mon Aug 25, 2008 4:52 pm Post subject: Re: New job, insurance coverage

Euan, you are in an enviable situation have two insurance companies to choose from. The usual subject is "where can I get insurance?" Laughing

.

I would look closely at both policies. Even though they are provided by the same company. It is possible to that the same insurance company would offer two different policies to two different companies. So, first, make sure the policies cover the same things... especially wait periods and cancer coverage.

If they are the same, go with the insurance company they your company has. It will not be a problem for you to switch to her policy if you should become unemployed and the other way around. To add a spouse, you do not need to wait for the enrollment period just as you do not have to wait to add a child. I really think that I am right but you should check this with both policies.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendroglioma grade 3, same location.
http://cancerforums.net/viewtopic.php?t=2405My Story Part 1: http://cancerforums.net/viewtopic.php?t=2528
My Story Part 2: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 3: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

shuggy1972 · Regular Joined: 31 Mar 2008 Posts: 28 Location: New York

Thanks, as ever, Jim!

What you say makes sense. I think that the two policies (i.e. the one we currently have with her employer, and the one I could get with my new employer) are pretty much identical, but I'll check all the small print.

I suppose what I need to understand the most is the pre-existing conditions rules. From what I can tell thus far, they can refuse to cover (for example) cancer treatment if the patient had any relevant diagnostic tests in the 6mth period prior to coverage taking effect.

I think that they can refuse this for up to 12mths - however because of HIPAA this 12mth period is reduced for every day that I had previous coverage. So for me, let's say I started cover with my new employers plan on 1st Oct, and then received a cancer diagnosis. They could refuse to cover any associated treatments, but only for a period of 3mths (i.e. their 12mths minus the 9mths of cover I had on my wife's plan).

I THINK that's correct, but I really want to make sure. More investigations for me.

Yes, I realise that I am one of the lucky ones in having insurance at present. I feel so saddened and angry on behalf of all the people on this forum who are fighting a horrible illness AND have to worry about medical bills they can't afford, or even worse are denied potentially life-saving treatments.

I won't go into a rant, but it just seems insane to me that, in such a modern, wealthy nation, there's such a stupid, dysfunctional healthcare system. The fact that most people rely on their employers for insurance is enough to tell you what's wrong - if you have some chronic or life threatening illness then that's precisely when you need insurance the most, and also precisely when you are most likely to lose your job!!! It's just crazy.

Also, for me, I am aware that even the scant safety nets which do exist should one lose coverage (i.e medicaid, social security) don't apply...because I'm newly here as a resident alien, and because I haven't paid any US taxes yet, then I'd qualify for precisely zero assistance. Hence the reason I am particularly nervous about doing anything to reduce or invalidate the cover we currently have.

Again, thanks for all your help and for the tremendous work you do running these forums.

Euan

brainman · Posted: Mon Aug 25, 2008 5:30 pm Post subject: Re: New job, insurance coverage

Yes, if there is a waiting period for cancer, stay with your current insurance. No big reason to risk being uninsured with a history of cancer. Prior to my recurrence, I went without an MRI for 2 years because I could not afford it on my own. When I finally got a job that did have health insurance, I had to wait 12 more months before I qualified for any coverage. By the time I finally was covered and had an MRI, my cancer had grown larger than the original. So, if you have to wait if you change, don't change is my advice.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendroglioma grade 3, same location.
http://cancerforums.net/viewtopic.php?t=2405My Story Part 1: http://cancerforums.net/viewtopic.php?t=2528
My Story Part 2: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 3: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

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