63 Days - Why?

[TXINSURANCE]

I had a client the other day question "why is the maximum break in coverage for pre - ex 63 days?" - My response was "it just is", then later "...blah blah blah HIPAA blah blah blah" and the client kept pushing me WHY? WHY? WHY not 60 days? 90 days? why specifically 63? Client finally asked me "don't you want to know why?".... lol...

So here it is... Specifically with Individual Health Insurance this is a real sticky subject.

-Some states allow individual as credible pre ex with no more than 63 day break in coverage (like Texas new law)

-Some states allow group as credible pre ex but not individual with no more than 63 day break in coverage

-Some carriers allow individual or group as credible pre ex but some do not, with no more than 63 day break in coverage

-Some carriers accept short term as credible, some do not, with no more than 63 day break in coverage

-Some states legislate short term as credible, some do not, with no more than 63 day break in coverage

-Some states don't play the 63 day game at all - they just credit portion of coverage in the past 18 months.

Huge state inconsistencies, even bigger carrier inconsistencies (imagine that...)

And of course my favorite... Clients think if they have no more than a 63 day break they can't be waivered, rated, or even declined.

Short answer - it is a huge mess.


But back to my question - WHY 63 DAYS? Who sat down and said 63 is the magic number - and why? Can anyone educate me on this?

p.s. One final funny note, our new group policy for my employees the carrier said 62 days.... Now I am really scratching my head.

 

[somarco]

If you want to maintain sanity, never try to make sense of anything congress does.

 

[djs]

My guess on this, and it's only a guess, is that they wanted 2 months. Now, if you say 2 months, and have a policy lapse on July 25, someone would be smart and say July and August are your 2 months, Sept 1 is the start of the third month. So they specified days.

Now, if those two months happen to be July and August (or December and January), you have 2 31 day months back to back, plus 1 day for paperwork, making it 63 days.

This is the best answer I can make up.

Dan

 

[arnguy]

I believe the rationale is that Congress decided on two months. In calculating calendar periods a month is considered to have 4.5 weeks. Thus, two months has 9 weeks and inasmuch as there are 7 days in a week (inrefutable) they multiply 9 x 7 which equals 63 days. Clear?

 

[TXINSURANCE]

I believe the rationale is that Congress decided on two months. In calculating calendar periods a month is considered to have 4.5 weeks. Thus, two months has 9 weeks and inasmuch as there are 7 days in a week (inrefutable) they multiply 9 x 7 which equals 63 days. Clear?

You might get the trophy on this one.

This should be real easy to explain to clients.

The big issue is HIPAA doesn't apply to individual and the credible coverage issue is of course all over the board.

 

[arnguy]

Tex, if all else fails, you can try to paraphrase those famous line from Lord Tennyson's poem, The Charge of thr Light Brigade:

Their's not to make reply,
Their's not to reason why,
Their's but to do and die,
Into the valley of Death
Rode the six hundred.

 

[Newby]

I had a client the other day question "why is the maximum break in coverage for pre - ex 63 days?" - My response was "it just is", then later "...blah blah blah HIPAA blah blah blah" and the client kept pushing me WHY? WHY? WHY not 60 days? 90 days? why specifically 63? Client finally asked me "don't you want to know why?".... lol...

So here it is... Specifically with Individual Health Insurance this is a real sticky subject.

-Some states allow individual as credible pre ex with no more than 63 day break in coverage (like Texas new law)

-Some states allow group as credible pre ex but not individual with no more than 63 day break in coverage

-Some carriers allow individual or group as credible pre ex but some do not, with no more than 63 day break in coverage

-Some carriers accept short term as credible, some do not, with no more than 63 day break in coverage

-Some states legislate short term as credible, some do not, with no more than 63 day break in coverage

-Some states don't play the 63 day game at all - they just credit portion of coverage in the past 18 months.

Huge state inconsistencies, even bigger carrier inconsistencies (imagine that...)

And of course my favorite... Clients think if they have no more than a 63 day break they can't be waivered, rated, or even declined.

Short answer - it is a huge mess.


But back to my question - WHY 63 DAYS? Who sat down and said 63 is the magic number - and why? Can anyone educate me on this?

p.s. One final funny note, our new group policy for my employees the carrier said 62 days.... Now I am really scratching my head.

Why does a foot have 12 inches?

Why does a yard have 3 feet? etc. etc. etc.

I was born in 1960 and when I was a little 3rd grader they promised us the metric system (everything based on 10) and that gave us all a big sigh of relief (cause it made sense) but all of our parents didn't understand a system that made sense so we are stuck with having TWO complete sets of expensive tools and if I have a 7/16 wrench in my hand and if it is a little too small I have to actually do fractions in my head to figure out what size is smaller rather than I have a 14 I must need a 13....this **** is out of control and has been driving me nuts since the 3rd grade!!! Why are there 12-hot dogs and only 10-hot dog buns??? Why do they call it a pair of pants when there is only ONE pant?? How much wood would a wood chuck chuck...???!!!!........BLAM! (My head exploded)

 

[retread]

The word is "creditable" not "credible". Creditable coverage is coverage that can be credited, creditworthy, etc. Credible coverage is coverage that is trustworthy, etc.

 

[joshril]

I have tried to find the TX insurance laws referencing these... Where can one locate all the legal info referencing creditable coverage?

 

[TXINSURANCE]

Josh - it is online I pulled it once, pretty sure. It would be part of the insurance code, I am sure TDI could give you the specific section if you call and ask.

In TX creditable coverage is both group, individual, and short term for about a year and a half. The group and individual is clear as day, the short term is gray because carriers do not give out certificates of coverage on short term and this is highly unusual. I had to fight this one through legal for about 3 months before they applied credit for my client.

And as usual carrier employees are hardly trained on any of this material.