Health care coverage continuation while incarcerated

[jeanine]

Opinions please. I've seen many self-funded plans that exclude coverage for injuries incurred as a result of committing a felony. What about claims that are incurred while the enrollee is incarcerated? The inmate could still be covered as a dependent of the employee or continuing COBRA coverage. In Ohio, the facility is required to provide access to health services and also required to submit bills if there is any coverage. If there is no coverage, the inmate is ultimately liable for the care except the govt entity (state, county) usually ends up paying. Do we need to rethink plan language or is a plan obligated to pay if the enrollee is incarcerated. Or am I missing some sort of exception here?

[Larry M]

Does the plan include an exception for services for which no charge is made in the absence of insurance?

[jeanine]

I don't think I understand your question Larry. My thoughts are that they have to pay claims as long as there is no loss of coverage. I guess this really matters when they are in for more than just a "short term stay" .

[Larry M]

a common provision in health plans is to say there will be no payment in the situation where no charge for services would be made in the absence of insurance.

So, for example, if the facility would charge the prisoner a fee for the medical care only if he had insurance, then the plan will not pay for such services.

[jeanine]

There is a charge for services regardless of the presence of insurance, although this is at the county jail level, not the state or federal penitentiary. (those might be "free"). The inmate is responsible for payment and can even have a lien attached to personnal property. I'm pretty sure we continue to administer our insured product and our clients self-funded plans without this exclusion, we were just asked if we could withhold by a potential client.