Declined for coverage

[Guest parrot87]

What are the options if a small group (4 employees on the health plan) canceled our policy to move to individual insurance, but one of the members was denied coverage? The group policy is set to expire on 9/1

Everyone else is covered. I thought insurers were required to insure since they've been on a group plan and that plan wasn't terminated for fraud or default payment. Any ideas how to proceed and get coverage before 9/1?

[leevena]

I am not familiar with each state and their laws, but, since you dropped to 1 life, you no longer have a group. Most states recognize a group as 2 or more. You should check with your broker, or go directly to the state department responsible for this and find out.

You might be able to go back to the carrier and see if they will keep the group if you meet the minimum enrollment, which may be all four for you group.

Good luck

[Guest parrot87]

No thats not what I meant, I mean that carriers are required to provide individual insurance (not group) IF certain criteria are met. I think I said that in the first sentence, sorry if I wasn't clear. This is a federal law. How do we relay this law to the carrier? Only one person got denied. She is 48, single, female, type A diabetic, and smokes. Otherwise healthy.

[leevena]

Again, I am not familiar with your state and it's laws, but I doubt very very much that carriers are required to provide individual coverage. Same suggestion, go to state or your broker. Hope this answers your question.

[Guest Sieve]

Do you mean, Matthew, that this group carrier does not offer a conversion policy for those who had been in the group? It's usually more expensive, and it's less coverage, but it's coverage nonetheless. Frankly, I don't believe it's mandated by federal law; it would, I think, as suggested, depend on state law. Even under COBRA, where the law requires that a conversion policy be offered to those whose COBRA coverage has expired, there is no requirement to offer such coverage if it is not generally available to non-COBRA beneficiaries under the group health plan--thus clearly implying that conversion policies are not mandated (unless there has been some new development that I'm not aware of--which certainly is possible).

[Guest parrot87]

There would be no COBRA in this case since the group plan no longer exists. I was under the impression that if all coverage options were exhausted (COBRA, Medicare, Medicaid, etc), the previous plan one was covered under was a group plan, there had been 18 months of continuous coverage, and the previous plan did not term due to non payment or fraud....that individual insurance was guaranteed under Hipaa, which I thought was a part of ERISA, a federal law the supercedes state law? no?

http://www.revolutionhealth.com/insurance/...insurance/hipaa

at the bottom of this link, there's a list of the requirements. I believe PA sets a cap on the rate up at 200%, which is ok for this member.

Sieve, that conversion policy you spoke of, is a group plan carrier required to offer a option to members? That would be a very nice plan B

[Guest Sieve]

My understanding of HIPAA is that you are protected from pre-existing condition exclusions in new coverage if you have been continually covered under an individual or group plan, but it does not require that any particular medical condition must be covered under the policy for anyone nor does it require an insurance company to even issue you a policy. That is still, I am sure, a creature of state law.

I would suggest you repost this question to the Health Plans in General, including HIPAA & COBRA topic.

[Guest parrot87]

Thank you Larry and Leevena.

Here's the repost in the other forum:

http://benefitslink.com/boards/index.php?showtopic=39611

[Guest Sieve]

By the way, the requirement of the option of conversion coverage following group coverage is, I believe, a state law issue.

[Don Levit]

Sieve:

Why would the requirement be a state law issue if it is in the Code of Federal Regulations?

Don Levit

[Guest Sieve]

Conversion is required by IRS regs to be provided following COBRA coverage run-out. But, the regs say that it is only required to be provided to the extent that it is provided to non-COBRA continuees. That obviously recognizes that some policies may not provide conversion priveleges. That's a state law issue. But, if conversion is offered to actives, then it must also be offered to COBRA continuees under the regs.

[Don Levit]

Sieve:

You are referring to the particular insurer who is providing coverage in which COBRA applies.

This particular situation concerns an employer in which COBRA was not offered.

Don Levit