Clinical health insurance requirements

pc2801 · Jan 8, 2012

I didn't have health coverage due to unemployment for past 3 years. I was given information on a plan from my school which was $40/mo for students. It states you will not be covered for 24 months for pre-existing conditions then asks about medical history for past 12 months. Since I had surgery 3 months previous following an accident I was denied coverage.

I then found BCBS "Go Blue Plans". They don't pay much for anything. They pay $50/lesser of accepted negotiated rates with your doctor and you pay the balance. They don't pay for ER and the like. Prescriptions they pay like $5/or less of normally accepted and you pay the balance. Its more like a discount plan than an insurance with a co-pay. But, I pay $26/mo and it meets the requirements my school has to have health insurance in the RN program.

ericaej · Jan 8, 2012

Have you looked at the health insurance plan available through the National Student Nurses Association?

https://www.uhcsr.com/NSNA

Also, most schools offer some sort of personal health insurance coverage. I think that the college I am looking at offers it for $450 for the year.

Jolie, BSN · Jan 8, 2012

You didn't ask for advice or information regarding health insurance coverage via your husband's employer, so feel free to ignore :) But I believe that you have either been mis-informed or perhaps misunderstood the issues regarding health insurance coverage for an individual (and family) with a pre-existing condition.

Unless there is something I am missing, if your husband's employer offers a group health insurance plan to employees, I am almost certain that they can not legally exclude your husband or the rest of your family from participating due to a pre-existing condition. (If it is an individual policy, that is a different story, but individual policies are rare in the employment setting.)

It is true that if your family chooses to participate in group coverage, your husband's condition may be subject to an exclusionary period, ranging from days to 18 months. This applies if he was recommended to receive treatment and/or received treatment for THAT condition in the 6 months preceeding your eligibility to join the group plan (which is usually based on one's hire date.) But if no treatment was recommended or provided in the 6 months prior to your eligibility date, then the pre-existing exclusion can not be enforced, even if a known condition exists. If he did receive treatment, insurance coverage for that condition ONLY, and nothing else can be with held for the exclusionary period, for him only, not the rest of the family.

This information comes from the following website: Frequently Asked Questions about Portability of Health Coverage and HIPAA

HIPAA is complemented by state laws that, while similar to HIPAA, may offer more generous protections. You may want to contact your state insurance commissioner's office to ask about the law where you live. A good place to start is the Web site of the National Association of Insurance Commissioners at National Association of Insurance Commissioners (NAIC).

One of the most important protections under HIPAA is that it helps those with preexisting conditions get health coverage. In the past, some employers' group health plans limited, or even denied, coverage if a new employee had such a condition before enrolling in the plan. Under HIPAA, that is not allowed. If the plan generally provides coverage but denies benefits to you because you had a condition before your coverage began, then HIPAA applies.

Under HIPAA, a plan is allowed to look back only 6 months for a condition that was present before the start of coverage in a group health plan. Specifically, the law says that a preexisting condition exclusion can be imposed on a condition only if medical advice, diagnosis, care, or treatment was recommended or received during the 6 months prior to your enrollment date in the plan. As an example, you may have had arthritis for many years before you came to your current job. If you did not have medical advice, diagnosis, care, or treatment – recommended or received – in the 6 months before you enrolled in the plan, then the prior condition cannot be subject to a preexisting condition exclusion. If you did receive medical advice, diagnosis, care, or treatment within the past 6 months, then the plan may impose a preexisting condition exclusion for that condition (arthritis). In addition, HIPAA prohibits plans from applying a preexisting condition exclusion to pregnancy, genetic information, and certain children. If you have a preexisting condition that can be excluded from your plan coverage, then there is a limit to the preexisting condition exclusion period that can be applied. HIPAA limits the preexisting condition exclusion period for most people to 12 months (18 months if you enroll late), although some plans may have a shorter time period or none at all. In addition, some people with a history of prior health coverage will be able to reduce the exclusion period even further using “creditable coverage.” Remember, a preexisting condition exclusion relates only to benefits for your (and your family’s) preexisting conditions. If you enroll, you will receive coverage for the plan’s other benefits during that time.

JustBeachyNurse, LPN · Jan 9, 2012

If you are attending a college, university, or community college most schools offer a basic student health insurance plan as many colleges have a requirement that all full times students have health insurance. It's often low cost. Some schools part time students are eligible but pay a slightly higher premium (like $100/semester instead of $50/semester). Check your state's department of banking & insurance for self-insurance options.

Do you have a case worker that helped you enroll in your state children's health insurance program? Often they have the information and resources to point parents in the right direction to get basic insurance coverage even if it is only "wellness & catastrophic" coverage covering basic needs for a generally healthy adult.

SunshineDaisy, ASN, RN · Jan 9, 2012

I agree, check with your school. Most schools have some form of insurance for students that are cheap. Our school requires it for nursing students, no matter what. You have to show proof before you can get your clinical ticket!

TnMtnRose · Jan 9, 2012

Jolie, thanks for the info. I myself don't completely understand all of it but its been a fit since he started there. I will be talking to my advisor this week to see if our school offers any coverage like y'all are talking about. I hope I can find something because I have a hospital 5 minutes from my house that I would love to do clinicals at but they are one of the ones requiring coverage.Thanks for all the great tips :)