Dependents

[bluemarlin08]

Dave,
Thanks for your response. I called BC again this morning to get further clarification and we are both right. When I spoke of a HIPPA policy, I really was referring to their guaranteed issue policy. It seems that my client's concern is a potential problem. If his wife has a change in health she is guaranteed a policy in the new state, but it won't be like her current plan and price. To qualify for a similar plan she would need to qualify medically. I see this as an issue that needs to be understood by clients that might be contemplating moving to another state.

 

[newmindfashion]

Dave,
Let me make sure I understand you because I do a lot of Anthem BC/BS business in CT and NH which are also Wellpoint/Anthem Blue states.

(1) Is the guaranteed issue reciprocity you mentioned only with the CA, NV and CO entities or also other Anthem/Wellpoint states like CT, NH, ME, VA, GA etc.?

(2) Since this Guaranteed Issue of roughly similar plan design is only allowed within some or all WellPoint states and is not association based, that would mean that a CA policy holder moving to FL for example (BC/BS of FL, not Wellpoint) could then be re-underwritten and only entitled to a Conversion through this J-4 wire and not a guaraneed issue roughly equivalent plan?

 

[Dave020]

Dave,
Thanks for your response. I called BC again this morning to get further clarification and we are both right. When I spoke of a HIPPA policy, I really was referring to their guaranteed issue policy. It seems that my client's concern is a potential problem. If his wife has a change in health she is guaranteed a policy in the new state, but it won't be like her current plan and price. To qualify for a similar plan she would need to qualify medically. I see this as an issue that needs to be understood by clients that might be contemplating moving to another state.

Yes, but HIPAA eligibility is predicated on loss of group coverage and can only be obtained when coming off of group coverage. HIPAA is not available for people on individual and family plans. It is guaranteed issue coverage under HIPAA, but only for those losing group benefits. The conversion plan is available under Blue for those who are on individual coverage since they do not qualify for HIPAA.

 

[bluemarlin08]

Yes, but HIPAA eligibility is predicated on loss of group coverage and can only be obtained when coming off of group coverage. HIPAA is not available for people on individual and family plans. It is guaranteed issue coverage under HIPAA, but only for those losing group benefits. The conversion plan is available under Blue for those who are on individual coverage since they do not qualify for HIPAA.

I can only go on what the local BC people tell me. The conversion is to a guaranteed issue plan and I specifically explained that the client would be on an individual BC policy. Unless they are willing to undergo medical UW, their only option on conversion is the GI policy, as I was told. I am not trying to argue, please understand, this happens to be a very good client I have worked with him and other doc in his practice for 20 years and want to make absolutely sure what I tell him is correct. Based on this information we are considering Assurant because he likes the PHCS network.

 

[Dave020]

I can only go on what the local BC people tell me. The conversion is to a guaranteed issue plan and I specifically explained that the client would be on an individual BC policy. Unless they are willing to undergo medical UW, their only option on conversion is the GI policy, as I was told. I am not trying to argue, please understand, this happens to be a very good client I have worked with him and other doc in his practice for 20 years and want to make absolutely sure what I tell him is correct. Based on this information we are considering Assurant because he likes the PHCS network.

Perhaps they are using the same policy for both. It may vary from state to state, here in CA conversion plans are specially designed plans only available directly from the carrier. HIPAA plans are mirror to individual plans with different pricing.

 

[bluemarlin08]

That's probably the answer! Thanks for your help. Here's another question I had a prospect run by me today. Family currently covered with HDHP with Mega. He now understands the challenges with Mega, but his wife is overweight and no one else would write her. We are conseidering taking him and his 3 sons off the Mega plan to Assurant ione deductible. Two questions, if Mega allows his wife to stay on the plan, is it worth it to have Mega versus no coverage? Secondly, if he makes his 2007 payment to their HSA, and then they drop the Mega policy, and futrue contributions go into the same HSA plan, can he use more than the 2007 contribution for his wife's expenses although she may not be covered, assuming she does drop her coverage?

 

[Dave020]

That's probably the answer! Thanks for your help. Here's another question I had a prospect run by me today. Family currently covered with HDHP with Mega. He now understands the challenges with Mega, but his wife is overweight and no one else would write her. We are conseidering taking him and his 3 sons off the Mega plan to Assurant ione deductible. Two questions, if Mega allows his wife to stay on the plan, is it worth it to have Mega versus no coverage? Secondly, if he makes his 2007 payment to their HSA, and then they drop the Mega policy, and futrue contributions go into the same HSA plan, can he use more than the 2007 contribution for his wife's expenses although she may not be covered, assuming she does drop her coverage?

I would definitely keep her on the Mega plan if she is a decline with another carrier. It is better to have some type of coverage than none, even if it's not the greatest coverage. Personally, I'd leave her on there. As to HSA rules, I am not the greatest expert in that area and I believe there are others on this board who can answer this better than me. I believe that HSA funds can be used to pay for expenses of the spouse even if he/she is not on an HSA plan, but you'd want to double check that. Dave

 

[J.R.]

I would definitely keep her on the Mega plan if she is a decline with another carrier. It is better to have some type of coverage than none, even if it's not the greatest coverage. Personally, I'd leave her on there. As to HSA rules, I am not the greatest expert in that area and I believe there are others on this board who can answer this better than me. I believe that HSA funds can be used to pay for expenses of the spouse even if he/she is not on an HSA plan, but you'd want to double check that. Dave

Go here http://www.hsainsider.com/roadrules.aspx and download the Road Rules book. It covers that topic (yes a spouse can pay for the other spouses eligible expenses) and then some.