shopping for health coverage individually. Limitations on pre-existing conditions clause?

[Guest cashcow]

I am a Treasurer of a small 501©(3) non-profit corporation. We have one employee who works part-time and is paying for his own health insurance. Even though as an organization, we cannot afford to pay for it, I want to help him find more appropriate coverage individually. The insurance he has is his former employer’s plan; he did COBRA for a while, then when it expired he continued the policy as an individual. He had a really bad car accident a couple of years ago, and he is afraid the pre-existing conditions clause will prevent him from shopping around. I am not aware of any other conditions he has and am really not in a position to ask considering I am kind of his boss.

His policy covers a lot but is expensive. He wants a cheaper one and is OK if the new one will cover less and/or have higher co-pays. I encouraged him to talk to his current company (Aetna) to see if they can offer him another policy with no exclusions for pre-existing conditions stemming from that accident. I also suggested that he research what’s available on https://www.ehealthinsurance.com/ and call a couple of providers he likes. Finally, I suggested to try a health insurance broker through http://www.nahu.org/.

Can you guys suggest anything else that may work in his situation? Is he really completely immobile with his health insurance because of that accident?

I appreciate the answers.

[masteff]

In 1996, HIPPA created portability between group health ins plans (the specific mechanism being that creditable coverage has to be counted toward pre-existing condition exclusion periods). But it doesn't force individual health plans to do the same (other than conversion coverage after COBRA has expired). However, check w/ your state's department of insurance to verify if your state has more favorable rules.

You might find this webpage from AARP helpful: http://www.aarp.org/health/insurance/artic..._insurance.html

My opinion: In addition to talking to an insurance broker in the state where the person lives, you might help him look into any associations that he might be eligible to join that may have group health plans for members. For example, I'm a member of my state's accounting society and was able to get affordable coverage thru them when I was unemployed; w/ proof of creditable coverage (aka, HIPPA certificate) I was able to avoid pre-existing condition exclusion.

Oh, and be sure the broker, insurance agency, etc, knows that he's had continuous coverage. He may not need a plan w/out an exclusion period so much as a plan that will credit his prior coverage.

EDIT: Pre-existing condition clauses usually only look at diagnosis/treatment during a specific time period prior to starting the new coverage. So if he's not had treatment/etc related to the car wreck recently, then it may not actually count against him. The real trick is to get full and complete information from the insurer about how they handle it, so he can determine if it really would apply.

[Guest sniffles]

Your best bet would be to contact Aetna and ask for a quote to go from your current plan with them to a plan with a higher deductible, etc. Aetna should be able to give you quotes on a number of different plans and should not have a problem with changing to one of those plans since you have had continuous coverage with them.

[Guest DentalMommy]

A discount Benefits plan might work well for him. He can save 25%-80% with no copays, deductables or high monthly costs. There are no qualifications, restrictions, limits, waiting periods or contracts.

Good Luck