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#52752 08-27-2003 04:24 AM
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ahartt Offline OP
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I thought this was worth repeating...

If you are considering changing jobs and are concerned about pre-existing condition exclusions, you should consider COBRA coverage (you may want to consider trying to negotiate an increase in salary with your new employer to cover the cost rather than insuring yourself through them). Please keep in mind that COBRA coverage is temporary coverage). For more on COBRA coverage and rules, visit:

http://www.cobrainsurance.com/

Generally, you should continue your health coverage under COBRA if you...
> have had comprehensive benefits and don't mind paying more for them
>want continual, guaranteed coverage at a higher cost
>have had recent health problems
>have had ongoing health problems
>are taking expensive medications
>have been declined for private insurance recently
>have a history of medical problems
>have had an accident within the 60 day window of enrollment
>are pregnant or planning to get that way
>got a job and your new employer does not offer a health plan


Amy
#52753 03-31-2004 08:48 AM
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I signed up for COBRA coverage and when I was elligible for enrollment in a new group policy I declined because I had already met my annual deductible on the COBRA policy and had already started chemo and radiation. I was diagnosed in July. In November the COBRA policy was changed from $1 million lifetime max to $250,000 which by the way, I had already reached. I was advised by the insurance company in late March that I had exceeded my lifetime max. The new company that was carrying me on self funded short term disability would not let me sign up for their group policy because I had to be "at work" in order to sign up. The new company called me Friday last week to tell me I would receive my last short term disability check today because they had sold to another company. The long term disability insurance I have been paying for has a 6 month waiting period and because I tried to get back to work October and November last year, I am 15 weeks from elligibility and COBRA will not cover this policy. Talk about feeling exposed right now. I have just passed my 6 month PET scan but if the cancer comes back I will need a neck dissection and wonder how I will pay for this. The state of Texas can put me on their risk pool plan and I only need about $700 per month with no income right now other than the $35k my wife makes. I was in a $110k job. What great news, huh?

Ed


SCC Stage IV, BOT, T2N2bM0
Cisplatin/5FU x 3, 40 days radiation
Diagnosis 07/21/03 tx completed 10/08/03
Post Radiation Lower Motor Neuron Syndrome 3/08.
Cervical Spinal Stenosis 01/11
Cervical Myelitis 09/12
Thoracic Paraplegia 10/12
Dysautonomia 11/12
Hospice care 09/12-01/13.
COPD 01/14
Intermittent CHF 6/15
Feeding tube NPO 03/16
VFI 12/2016
ORN 12/2017
Cardiac Event 06/2018
Bilateral VFI 01/2021
Thoracotomy Bilobectomy 01/2022
Bilateral VFI 05/2022
Total Laryngectomy 01/2023
#52754 03-31-2004 05:33 PM
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Thanks for the reminder, Amy!

I feel with you Ed, My Minnesota "Care" was supposed to be the new solution for very small business and folks that didn't qualify for other insurance. In August 03 we got a letter from the state: we no longer qualify (because they changed the rules) and would not have coverage. The gave us two weeks to find something else! (the great state kicked some 10,000 people off all at once). We did find something short term and now my wife went back to full time work at a company with full benefits and took me on even with my history. I completely know what you mean about feeling exposed.


Mark, 21 Year survivor, SCC right tonsil, 3 nodes positive, one with extra-capsular spread. I never asked what stage (would have scared me anyway) Right side tonsillectomy, radical neck dissection right side, maximum radiation to both sides, no chemo, no PEG, age 40 when diagnosed.
#52755 04-02-2004 07:18 AM
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When changing employers, HIPAA regulations can often eliminate any preexisting condition exclusion, so you don't necessarily need to elect COBRA if you are "HIPAA protected". When joining a new group plan, you get credit for previous health insurance coverage and can use it to reduce the exclusion period. This is one of the reasons why electing COBRA if you are NOT leaving for other employment is so important...it will continue your creditable coverage so that when you DO get another job, you won't have to wait out the preexisting condition period.

http://www.cms.hhs.gov/hipaa/hipaa1/content/hipsteps.asp#Step3

#52756 04-03-2004 06:23 AM
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Here's another COBRA related question: When my husband dies (soon, we are told) I will no longer have health insurance because he carries me and my daughters on his plan through his employer. I will have to continue with COBRA coverage, but it will be 4X what my husband pays now. Imagine--I will be reduced to one income, and COBRA will be nearly half my monthly take-home salary as a public school teacher. Alternately, I could take on coverage through MY employer during open enrollment in the fall, but even there a family plan costs almost as much as the COBRA will cost.

My question: will I be able to seek out health insurance through an independent company rather than my empoyer? And if so, how do I know if I'm getting a "good deal" and reliable coverage? I'm so worried about this. Right now, my daughters and I are healthy and always have been, but I'd be terrified to go one minute without coverage, yet I can't afford to pay the outrageous prices that a family plan costs. (We really had a good deal through my husband's employer.)

Christine


Wife of Scott: SCC, Stage I retromolar 10/02--33 rad; recurrence 10/03--Docetaxol, 5FU, Cisplatin; 1/04 radical right neck, hard palate, right tonsil; recurrence 2/04--mets to skin and neck; Xeloda and palliative care 3/04-4/04; died 5/01/04.
#52757 04-03-2004 06:58 AM
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Christine, my understanding of COBRA is that they can only lawfully charge 105% of the original premium. I am amazed that you don't have great coverage as a teacher. I was a classified employee for a school district for several years and the one thing they didn't scrimp on was health insurance coverage. We had a choice of 3 different health plans. You can always reduce your premium costs with higher co-pays. If you and the kids are really healthy you may be able to find a plan as low as $400.00/mo but with a $50.00 co-pay. It probably wouldn't hurt to talk to a broker and see what they do for you.

My wife and I are paying around $1,000.00/mo. for medical coverage (we have a $5.00 co-pay) it has vision and dental also. We are both self employed.


Gary Allsebrook
***********************************
Dx 11/22/02, SCC, 6 x 3 cm Polypoid tumor, rt tonsil, Stage III/IVA, T3N0M0 G1/2
Tx 1/28/03 - 3/19/03, Cisplatin ct x2, IMRT, bilateral, with boost, x35(69.96Gy)
________________________________________________________
"You are a mist that appears for a little while and then vanishes" (James 4:14 NIV)
#52758 04-03-2004 11:40 AM
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I believe you are correct on the 105% Gary, but the employer is not required to pay any part so you are required to pay the total amount including what the employer used to pay. Cobra is usually no bargain unless you have no other choice. It is however an important in-between coverage to keep while you are changing insurance. Many companies will waive a waiting period if you have had continuous coverage.

Christine, My wife and 3 kids were pretty resonable through a private (Blue cross) plan. The best prices are policies with high deductable and co-pay amounts. Check with the agent you buy homeowners or auto insurance. They might be able to offer something. Thank you for the update on your husband. Give him my best regards, and I am sorry I'll not be able to meet him on this side.

There was a time when I considered the reality that we could go broke paying for insurance, or go broke if we got sick. It isn't a very good choice to have to make.


Mark, 21 Year survivor, SCC right tonsil, 3 nodes positive, one with extra-capsular spread. I never asked what stage (would have scared me anyway) Right side tonsillectomy, radical neck dissection right side, maximum radiation to both sides, no chemo, no PEG, age 40 when diagnosed.
#52759 04-04-2004 01:52 PM
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Posts: 116
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Mark, apparently my husband's employer does cover huge amount of his insurance for COBRA to be so high (and for his share to be so low now).

And Gary, as for public school teachers' insurance--it really stinks out in here in VA. There may be some school systems that offer good benefits for teachers, but the two I've worked for in the last few years have both had horrible "benefits" and sad pay compared to the rest of the state. I live in the "country" and the tax base can't match up to that of school districts near Washington, D.C or Virginia Beach, for example.

I have another question about insurance. I've seen on this board where several times some of you suggest folks get life insurance and other forms of protection before a possible cancer diagnosis. I have been worried about one policy my husband and I took out just after we were married and only two months before he had a doc look at a lesion in the back of his mouth that turned out to be T1 SCC.

At the time we took out the policy, the insurance salesman made us fill out tons of forms answering questions about habits (drinking, smoking, exercise), health, etc, then told us the rates for our coverage--mine a pittance for a larger policy since I don't smoke and never have; and a heftier price for a smaller policy for my husband who had smoked a pipe for a number of years. We also had a health worker come to our home a week later to draw blood and take urine samples, then we visited a doctor for a physical exam.

Well, I've been worried about that policy because of all the hoops they made us jump through to get coverage. Since my husband's cancer was diagnosed so soon after getting it (like I said, around 2 months) I worry about whether I will be able to depend on that policy to help pay off our home (that we had JUST BOUGHT at that time). I'm just worried that they will try to wriggle out of honoring the policy even though we really had no idea that Scott would soon learn of cancer. I know it's silly to worry about this now, but my husband and I have been forced to "take care of financial matters" with his terminal prognosis and we're hoping my daughters and I can stay in our home. (I could never pay the payments on my teacher's pay, esp. not with the probable higher cost of health insurance!)

Christine


Wife of Scott: SCC, Stage I retromolar 10/02--33 rad; recurrence 10/03--Docetaxol, 5FU, Cisplatin; 1/04 radical right neck, hard palate, right tonsil; recurrence 2/04--mets to skin and neck; Xeloda and palliative care 3/04-4/04; died 5/01/04.
#52760 04-04-2004 03:44 PM
Joined: Dec 2003
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Christine,

I am so sorry you have to deal with so much right now. My heart goes out to you. Find the insurance policy and read it. Many policies have a period of time that prevents claims from being allowed. For example, much of the AFLAC cancer policies have an exclusion if cancer is diagnosed in the first six months of the policy. Most credit life insurance has a three or six month exclusion period. My life insurance does not have an exclusion period but I have had it for four years. You can also contact the American Bar Association and request pro bono legal advice. When you give them your circumstances, you will most likely get the answer you need without cost. Please keep us posted. I wish you the best.

Ed


SCC Stage IV, BOT, T2N2bM0
Cisplatin/5FU x 3, 40 days radiation
Diagnosis 07/21/03 tx completed 10/08/03
Post Radiation Lower Motor Neuron Syndrome 3/08.
Cervical Spinal Stenosis 01/11
Cervical Myelitis 09/12
Thoracic Paraplegia 10/12
Dysautonomia 11/12
Hospice care 09/12-01/13.
COPD 01/14
Intermittent CHF 6/15
Feeding tube NPO 03/16
VFI 12/2016
ORN 12/2017
Cardiac Event 06/2018
Bilateral VFI 01/2021
Thoracotomy Bilobectomy 01/2022
Bilateral VFI 05/2022
Total Laryngectomy 01/2023
#52761 04-05-2004 05:50 AM
Joined: Mar 2004
Posts: 8
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Posts: 8
Christine...would your kids possibly qualify for health insurance through the state? I know people who've been unable to afford private family insurance who've gotten the kids on state provided insurance and just bought an individual policy for themselves.

http://www.vhcf.org/Child%20Health/Child%20Health.htm

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