Health insurance for student w/chronic illness

Parent Cafe
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<p>Opie - I’m an attorney who specializes in labor law and ERISA. I spend much of my time representing employee benefit plans that fall within the scope of ERISA (which for purposes of this thread includes virtually all employer group health plans and also includes all jointly administered Health and Welfare Funds and the health plans they maintain either on an insured or self insured basis) and I also devote a fair amount of time negotiating benefits on behalf of employees with employers. As such, I have a pretty good familiarity with ERISA, HIPAA, COBRA and the plethora of federal statues and regulations that impact on health benefits and how those enactments interface with state insurance laws.</p>

<p>You are correct that insurance laws and regs vary from state to state. However, as you note, ERISA preempts state laws that would otherwise apply to “health plans” as do HIPAA and COBRA with respect to group health plans. In practical terms, what this means is that if you get your medical insurance through your place of employment, in all likelihood you are covered by these Acts and their regulations which will supersede state law. Generally, it is the individual plans that people purchase on their own through an insurer and the insurance companies themselves that fall strictly within the purview of state insurance laws and regulations but even there, there are federal statutes that mandate that insurers provide certain scopes of coverage (such as the Mental Health Parity Act) or otherwise regulate such plans (such as HIPAA’s privacy regulations). </p>

<p>As to the OP, military health plans are regulated by federal law applicable to military service. They are, however, “group health plans” for purposes of HIPAA and therefore if the OP’s daughter transitions from her parents’ military plan to a group health plan through an employer, the full scope of HIPAA portability protections will apply. When the time comes for the OP’s daughter to switch plans, if problems arise she could also seek assistance from the DOL’s Pension Welfare Benefits Administration and even from EEOC with respect to discrimination claims under the ADA.</p>

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<p>I will call the OIC to confirm some of these things in my state. I have a kid with an uninsurable condition. I asked a few companies who all told me it is uninsurable. Insurance without coverage for the condition is pretty worthless. My understanding is that we can COBRA her for 18 months after she graduates if she needs it but then (if not before) she needs s job with health benefits. That seems to be the bottom line from what I can tell. My big concern is also graduate school which she might want to do later. I assumed (am I wrong?) that, like undergrad, schools provide some come of insurance for students. I’ve been told that kind of health care is substandard for those with chronic health concerns but, I suppose it is better than nothing and she could consult with a private doctor out of pocket if considering a change in meds. Does anyone know if grad schools provide insurance? Our state is only to 25 for full-time students. But I am going to call. When first diagnosed (during college) the first kick in the gut for me was realizing the implications of the illness; the second one was realizing the implications re health insurance. My d knows that she needs to work a job with health insurance. That’s just the reality. It certainly has made me want to see some real reform take place ASAP.</p>

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<p>mimk6 - as I mentioned earlier, if in grad school your child has a paid position within the university (RA), then medical insurance should be provided; they will be considered an employee of the university. Again, it depends on what they’re going to grad school for, if the degree requires research. Being a TA might not qualify as TA positions aren’t usually full-time, but again, these are things to look into when the student is looking at grad schools. We had wonderful health insurance when my husband was both in grad school and completing a post-doc. Because it was a large university, it also had a medical school, so we had access to great care (thankfully never needed it).</p>

<p>When you mention that your state is only to 25 for full-time students, I would defer to MichaelNKat to see what federal laws apply that supercede your state laws. Actually, the coverage our children have until age 25 is determined by my husband’s employer - the employer chose to extend benefits to this population as it follows IRS guidelines for determining dependency status on your tax return. Perhaps MichaelNKat can comment further to this as I was told this is a trend, to implement IRS guidelines for dependency qualifications on health insurance. Just a trend, but a good one in my eyes. And maybe just for larger groups?</p>

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<p>mike, just so we don’t lose anybody here would you agree the best and first place to start is their plan booklet? This should spell out answers for many of the question this person has. From there move to the OIC for advice as the OIC does not sell product, they regulate it. </p>

<p>One concern about portability would be in the details… again 99% of the time portability allows for wing walking (stepping from one plan to another) and no preexisting conditions, but it is not that way 100% of the time… it may depend on going from group to individual, from a thin plan to a fat one. </p>

<p>This is my concern when folks start asking about their specific health plan. It is hard to advise with accuracy if you don’t know the entire federal and state details in the mix. It may also depend on head count of a business. I have groups of five offer cobra because of the definition which has nothing to do with the insurance plan enrollment and eligebility… </p>

<p>There are just alot of variables in each situation. Get your plan booklet, earmark or note the things you don’t understand… and that’s ok to admit that after 20 years in the business I still do this… call the company and walk through it UNTIL you do understand it… they will give you that kind of time…
Then if you need clarity and certainity call your OIC… I use em all the time. They are a great reasource to the public and professionals.</p>

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<p>My son also has type 1 diabetes and I worry about how he’ll manage (financially) once he’s done with school and leaves our plan. He took a gap year (in Europe for 7 months) last year and paid for the COBRA coverage himself, so he knows how expensive it is. He knows that unless he finds a job through a large employer and signs onto their health insurance plan right away, he won’t be able to get affordable, good coverage. He knows that he can’t have any gaps in his coverage. As an earlier poster mentioned, diabetes supplies are very expensive and he will need them for the rest of his life. </p>

<p>Luckily our health plan just eliminated the upper age limit for full-time student coverage. As long as he doesn’t get married, he’ll be covered through grad school.</p>

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<p>mimk6 - It’s always risky to give “legal advice” based on internet dialogue, but I would suggest looking into the following. I assume from your post that your daughter is on your plan and her condition is covered by the existing insurance. If that is the case, then there are some options. First, loss of dependency status is a COBRA qualifying event that entitles the former dependent to elect continuation coverage for 36 months, not 18 months. So, she could continue on the same plan as you for up to 36 months after losing her dependency status based on age. That might get her through grad school. Then she takes a job with an employer that has group coverage and gets a certificate of creditable coverage from your (her) former plan so that there is no pre-existing condition exclusion with her new plan through work. Odds are that her condition would not be excluded from another group health plan in your area if it is covered under yours (as opposed to an indiviual health insurance policy). Without knowing more details it’s tough to give more concrete advice including whether efforts to exlude coverage of your daughter’s condition as “unisurable” violates other laws including the Americans with Disabilities Act. Because of the importance of these issues, you really should invest some time consulting with an attorney in your area who specializes in healthcare or benefits law and work out a long term game plan.</p>

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<p>Thank you for the advice. Here is what I learned today in regards to California. Dependents can stay on their parents insurance if they are full-time students up until age 25. A student can get 36 months of COBRA after graduation if needed. What I was told by the person I spoke with at the insurance commissioners office was that after COBRA runs out, she will get a guarantee issue letter and if the company offers individual health plans, they have to insure her and they can’t turn her down for a pre-existing condition and they cannot charge her more than someone else. It needs to be done within 63 days. Of course, the same would be true if she had a job and left – she could get the guarantee issue letter. The rub is that if it is a company that only does group insurance, she’d be out of luck. So I was wondering if a person should stick with a plan they get when they are young and pay the premiums because there might come a time in life when they are out of work or want to take time off to raise a family and they can’t get that guarantee issue letter. I then spoke to the Dept of Labor after the first guy advised me to for one question and the woman there seemed very suspicious of what I had been told – she believed that once someone starts making lots of claims on an individual plan, the plan will drop them. I guess we’ve all heard stories of that happening. So I’m not sure how secure she could be with an individual plan after COBRA. Thanks for the advice – if anything seems off about what I was told, I’d appreciate knowing.</p>

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<p>“So I was wondering if a person should stick with a plan they get when they are young and pay the premiums because there might come a time in life when they are out of work or want to take time off to raise a family and they can’t get that guarantee issue letter.”</p>

<p>Not sure what your trying to say here…could you rephrase that? </p>

<p>" I then spoke to the Dept of Labor after the first guy advised me to for one question and the woman there seemed very suspicious of what I had been told – she believed that once someone starts making lots of claims on an individual plan, the plan will drop them."</p>

<p>Again go with what you were told at the OIC. they actually have the codes in front of them… the L&I lady is wrong… the OIC will tell you the truth in regards to health insurance issues. The L&I lady will tell you the truth in L&I issues… beyond that, she’s the same as anybody here. </p>

<p>“I guess we’ve all heard stories of that happening. So I’m not sure how secure she could be with an individual plan after COBRA.”</p>

<p>OIC. I can only give you WA examples. Individual coverage is basically a large group plan with demographics driving rate changes, not individual claims. If they raise rates they will do it across the board or for an entire “class”. In WA, rate increases have to be approved by the OIC. The carrier has to show a need to increase and the increase has to be approved by the state. </p>

<p>Thanks for the advice – if anything seems off about what I was told, I’d appreciate knowing. </p>

<p>Thanks for being proactive and talking with your OIC.</p>

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<p>In Illinois, all full-time students, be in undergrad, grad, or professional, must have health insurance. The quality of the policies vary. Some are in house HMOs and some are broad PPOs. The name of our insurance policy is CampusCare, and students tend to call it CampusScare.</p>

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<p>Do you know if a graduate student who is on a group health plan because of a fellowship, in NY, but is not working this year as a TA, is entitled to a COBRA? My son received a continuation of coverage letter, for when the fellowship ends next August; the continued coverage they offer is for one year, at a fairly hefty rate – does that mean that he doesn’t get the full 18 months? I will certainly look more carefully at the materials, but they are confusing – I wondered if any of you had any experience of this variation on the issue.</p>

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<p>Mamenyu if you want pm me. I need more detail about group size, insurance carrier. Cobra is not automatic in all situations.</p>

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<p>Opie, sorry I was unclear. What I meant is, if someone who may have trouble getting an individual policy later can get one going off of COBRA with a guarantee letter, might it be wise to hang on to that insurance and pay premiums even when they start a job with health benefits, essentially keeping it as backup insurance? There may not be a letter of guarantee in the future if the company worked for is insured by a company that only does group insurance. In that event, the uninsurable person would not be able to get a good private plan if the job ends. Keeping the insurance from gotten from a letter of guarantee (assuming they truly cannot drop from too many claims) would allow this person to make career decisions and so forth without the fear of not having insurance. I guess I wonder if that kind of security is worth the money. As to what the OIC said, he did say insurance gotten after COBRA can’t be revoked for a pre-existing condition but in CA there have been cases (published in LA Times) of companies, particularly Blue Cross, terminating insurance policies when the individual started making too many claims. Granted those policies may not have been gotten through a guarantee letter but it does give one pause.</p>

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<p>The guidelines are also ever changing with regard to health insurance coverage. My husband’s company (in Massachusetts) says it MUST offer coverage to dependents until the age of 26 OR two years after they are no longer dependents…whichever comes first. That is VERY good, I think. AND the kids do NOT have to be students. In CT, the health insurance coverage for dependents will change as of Jan 1, 2009. I believe as of that date, all dependents must be covered until age 25…and again, they do NOT have to be full time students.</p>

<p>We too are concerned re: health coverage for a college student with a chronic medical condition. If need be, we will subsidize insurance for this child. We hope he’ll be in a group plan and there won’t be an issue. But it IS a worry…but I’m not going to worry about it until he’s 25…I’m sure he’ll be a dependent until then!!! Right now we’re still declaring him as a dependent on our taxes too. </p>

<p>I am strongly interested in health care reform. The costs of health insurance…especially for our young people some of whom do have medical issues, is staggering…and this should not be the case in the wealthiest country in the world.</p>

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<p>I am starting to think about it because DD graduates in May and is now applying for jobs, fellowships, etc. and talking about graduate school in another year or two. Some of the opportunities she is applying for would provide coverage, some might provide an incomparable and career-building experience but no coverage, etc. At least there is COBRA. I also would like to see health care reform especially as some companies are starting to reevaluate the cost of health insurance.</p>

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<p>I am the HR manager for an under 50 employee company who has been offering COBRA to departed employees for all 18 years of my employment there needlessly because only companies with over 50 employees are subject to COBRA. No!!! The law is companies with over 20 employees are subject to COBRA. Here in Massachusetts the law requires that we continue coverage for dependents till the age of 26 whether they are full-time students or not. I have a employee whose "07 grad daughter has Crohns and even though she works retail for a large company, she is kept under 32 hours and ineligible for benefits. The first thing I did when the law changed was inform this very worried father that her coverage would continue. BTW, I have had RA since they age of 16 (I am now 56) and I have never had a problem with coverage. You will need to make certain she has continous coverage so that under HIPAA she would not be denied coverage when she changes employers.</p>

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<p>“The law is companies with over 20 employees are subject to COBRA.”</p>

<p>Actually for the record, a company is cobra eligible if it employs 20 people on any given day… including part timers. You can have a company that has 5 people on it’s health plan (plan hrs. reguirement set by employer for eli) and 40 part timers… who on one day happen to have 20 on the clock and you have a cobra group. Cobra qualifies based on who’s working not how many are on the plan.</p>

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<p>“What I meant is, if someone who may have trouble getting an individual policy later can get one going off of COBRA with a guarantee letter, might it be wise to hang on to that insurance and pay premiums even when they start a job with health benefits, essentially keeping it as backup insurance?”</p>

<p>Always the best thought is to “wing walk” step from one plan to the next without a gap. So after someone on cobra starts working elsewhere, it is a good idea to keep the cobra coverage going until the new kicks in. Then no questions or gaps of uninsurance. Depending on the state, you may be allowed a gap of 60-90 days without coverage but still be able to waive pre existing clauses. However, if during that 60-90 day you go without coverage, it’s your bill. </p>

<p>To keep an extra policy while on a new company plan might be a bit much overkill, unless it’s to fill gaps in the employer sponsored plan. It wouldn’t be a good use of money to carry a fat extra policy. </p>

<p>“There may not be a letter of guarantee in the future if the company worked for is insured by a company that only does group insurance.”</p>

<p>the letter your thinking about really declares you had coverage until "x"date. It may not be a certainity of coverage… it will depend on your states Pre ex rules. Usually an insurance carrier issues a certificate of prior coverage so the insured can show the new insurance company they were covered. </p>

<p>“In that event, the uninsurable person would not be able to get a good private plan if the job ends.”</p>

<p>Again, it will depend on your state. I would say in the last 10 years most states have adopted some portability rules to ensure people who had coverage are able to maintain coverage when they switch jobs. </p>

<p>" Keeping the insurance from gotten from a letter of guarantee (assuming they truly cannot drop from too many claims) would allow this person to make career decisions and so forth without the fear of not having insurance. "</p>

<p>again this is why I have always posted contacting your OIC and check on if a plan and agent selling it, is licensed to do business in that state. The internet and cheap mailers have sucked more people into bad choices where they “think” they’ve bought good insurance only to find out too late they bought paper. A licensed plan must follow state guidelines and is responsble and ACCOUNTABLE to the OIC for what they sell in your state. If are looking at purchasing coverage from company A but can’t find if they are licensed to do business in your state… wait… let them prove it.</p>

<p>"As to what the OIC said, he did say insurance gotten after COBRA can’t be revoked for a pre-existing condition but in CA there have been cases (published in LA Times) of companies, particularly Blue Cross, terminating insurance policies when the individual started making too many claims. "</p>

<p>I actually go to an insurance website and know of this story… the real problem is the lady committed fraud on the application. She lied. She got caught. She got cancelled. Had she been honest on the application, yes, she would have paid more due to risk, but she’d been covered. </p>

<p>As someone mentioned eariler the MIB. The MIB is a records clearinghouse where EVERY Insurance claim someone’s ever had resides. If you had a bypass 10 years ago and the application asks Have you ever had a bypass? and you answer no… fine they might look or they might not, till you have a large claim. Then they check the mib, if something’s there and it differs from what you apply for … </p>

<p>“Granted those policies may not h"ave been gotten through a guarantee letter but it does give one pause.” </p>

<p>Actually if she had prior group coverage, she would have faired better.</p>

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<p>I am, but I’m fairly new. Got my license about 6 months ago. Currently captive agent.</p>

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<p>thumper1:

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<p>I am interested too. I think Congress should have laws to stop employers from providing health insurance for employees and let every individuals have equal rights to buy insurance regardless of pre-existing conditions. Employers should have no business in dealing with insurance. Why employers don’t just pay for employees to buy? Employers tend to provide lousy insurance benefits for employees and employees have difficulties in career move because of health insurance.</p>

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<p>My son (turned 22 in Dec, 2007) has Crohn’s disease and will graduate in June, 2008. He is deciding between 2 options after graduation. As much as I wish he didn’t have to worry health insurance in his decision, I think it needs to be one of the considerations.</p>

<p>Plan A: Work for one to two years and then go to grad school (full-time) for 2-3 years (depending on which grad school he attends).</p>

<p>Plan B: Go directly to grad school for two years.</p>

<p>We currently have our family insurance through my husband’s company (4 employees) so COBRA is not an option there. This plan covers our son until the end of the calendar year that he turns 24 (2009) as long as he is a full-time student.</p>

<p>At the next open enrollment, I could pick up health coverage with my employer, where COBRA would be an option. I will have to check into what age dependents are covered with my employer.</p>

<p>Questions? (Opie, I would really appreciate your comments.)

  1. If my son works after graduation, and then returns to full-time grad school, can he be added back onto our family insurance plan (assuming he has not reached the maximum age)?
  2. Does an individual need to be covered by a plan for a minimum time to qualify for COBRA?
  3. Should I encourage my son to go directly onto grad school so that he will be covered continuously by my husband’s insurance (or mine if I pick it up)?
  4. If he is on our insurance until the end of 2009 (year he turns 24), but he is not yet out of school, and if COBRA is not an option, then what are his coverage options? Student insurance through the school until he is employed?</p>

<p>Thanks all.</p>