Health Insurance Questionanaires

[krissy_gale]

My employer is switching our group insurance provider mid year, effective June 1st. This is after I've met my deductible and max out pocket, I will only get credit for my deductible with the new insurance plan. I have a medically fragile daughter and she has many medical issues and diagnoses. Open enrollment closed on May 19th, today I received an email requesting that I fill out this questionnaire for each one of my daughter's diagnoses and have it to them by tomorrow. I need to know why they would be asking me for this and is it something I have to provide? It would definitely take me longer than one day to provide the information accurately. This is a group health plan through my employer and I thought denying insurance on preexisting was not allowed anyhow. We live in Texas if that makes a difference.

addition health questionnaire (1).pdf

[hr for me]

Going to brainstorm a bit....

(1) it's not a grandfathered plan since they switched providers (and would have had to keep close to the same % benefits and carrier, etc since 2010 to be grandfathered) -- so they have to fall under all the PPACA provisions, of which one is covering preexisting conditions and the list of minimum essential benefit, so you are correct there.

(2) Have you asked HR/employer the purpose of the questionnaire? Is it for 'wellness' reasons to help the employer/insurance company/EAP/Wellness group to help you with the issues?   eta: just clicked on your attachment and at the top it states WELLNESS.  Wellness plans are fully legal and employers are allowed to ask these types of questions but do have to be careful what is asked and how -- so as to not discriminate under ADA, GINA or other laws.

(3) Often the insurance company will have employees fill out new enrollment questionnaires at time of enrollment, or when the employer switches carriers. (BCBSTX didn't used to require it but UHC did, not sure if they do now since we have stayed grandfathered under BCBSTX since 2010*) Some are known for more invasiveness than others. Usually they are trying to figure out possible actual claim rates (even if the employer is rated by age/area/smoking only) and exposures.   They may be trying to get more information on the types of medications, etc since they will have their own formulary.  Or just to get a background of current/pre-existing issues so that it is on file at your time of need (which could be an emergency with no time to spare)

They can't deny coverage, but it is my understanding that they can require you to fill it out to be covered and might refuse to cover something you do not disclose (you need to read any small print on the form). Do your best, don't lie and possibly include a statement on the questionnaire that due to all your daughter's issues, you have answered to the best of your ability in the short time frame that you had. Offer to give a more complete analysis if more time is given.

If it is a small employer with 2-50 employees, you might check out this website: http://www.tdi.texas.gov/pubs/consumer/cb040.html

*I did find a current Aetna enrollment  questionnaire for TX employees and yes, it did have the medical questionnaire that I referenced in #3.