GA HIPPA Elegable Individual W/ Pre-existing on Cobra Until 6/10

cornelius322

Expert
22
Hi,

I am a Georgia resident, laid off from a Fortune 500 company 12/31/08 (company group policy is self-insured; insurance managed by United Healthcare). I am currently on Cobra; wrapping up a temp job out of state (that didn't go perm) and returning to Georgia.

If I find myself 6/30/10 without access to group coverage, what are my options? (actually entrepreneurship appeals to me). I am single, 40, and in remission from Crohn's disease that I was diagnosed with in 2008. I take the expensive biologic drug Humira to maintain remission. Since I should be HIPPA eligible, what are my options going to be in Georgia for an individual policy?

My main goals are to prevent getting financially wiped out from a hospitalization. I recognize that my prescription drug benefit (if any) will not be as generous as my current one (I pay next to nothing for my Humira) and that I may have to apply to Abbot Labs (maker of Humira) for their patient assistance program. I am currently on a schedule of having colonoscopies every other year; and my doctor uses a more advanced form of a CT-scan (ct-enterography) to also monitor my condition.

I can accept that my premium might cost as much as monthly rent or a mortgage. My primary question is first and foremost will I be able to obtain coverage, and what is it going to cover?

Thank you in advance for your feedback.
 
Re: GA HIPPA Elegable Individual W/ Pre-existing on Cobra Until 6

You don't want to hear this, but you are probably all but screwed unless you can come under a group plan . . . or Obamacare, whichever comes first.

GA has a HIPAA conversion plan (assignment) but not a risk pool. Coverage under your former employer is most likely self funded which eliminates the possibility of coming under the assignment plan.

Contact me if you want to discuss further. I can tell you how to qualify for a small group plan as long as you will have at least 2 folks on the payroll.
 
Re: GA HIPPA Elegable Individual W/ Pre-existing on Cobra Until 6

RE: HIPAA guarantee issue
Is Georgia a "Alternative approach"state as opposed to he "federal fallback" that we have here in California?
 
Re: GA HIPPA Elegable Individual W/ Pre-existing on Cobra Until 6

Somarco, my employer was Coca-Cola (corporate; North avenue) if that's of any help.

I would meet 1, 2, 3, 4, and 5 (in bold below). Why wouldn't I "be eligible for coverage under the Assignment System" when I would meet all five requirements? (just venting because I'm frustrated, not at you). BTW, from another post of yours, who is the carrier "BX"? Thanks!

Question: What are the qualifications for coverage under the Assignment System?

Answer: In order to be eligible for coverage under the Assignment System you
must meet the following guidelines:

1) You must be a Georgia resident.

2) You must have completed Cobra, if it was available.

3) The previous group plan you were covered under must have been self –insured or the policy must have been issued out of another state.

4) You cannot be eligible for any other health insurance policy, including Medicare, Medicaid, group or individual coverage.

5) The insured must have 18-months of previous creditable coverage.
 
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Re: GA HIPPA Elegable Individual W/ Pre-existing on Cobra Until 6

GA doesn't have a risk pool, nor do they have the "usual" options for HIPAA conversion. When you exhaust COBRA your option is enhanced conversion (if your COBRA carrier offers such) or the assignment plan.

With assignment you apply to the GA DOI via the application link above. If you meet the criteria set up via statute, the DOI assigns you to a carrier, usually BX (Blue Cross) on a rotational basis. You could get Aetna, Humana, Cigna, Mega (yuk) but most folks end up with BX. The assignments are handed out according to how much total business the carrier writes in the state. BX writes more than anyone else so they also get the lion's share of assignment candidates.

Cornelius, unless things have changed in the last year, assignment is not available to those who come from ERISA (self funded) plans. Some ERISA plans will issue conversion coverage but I don't believe KO does. I have clients who are former KO employees but all of them were insurable. We had some challenges getting some of them covered and they never mentioned options from the plan administrator once COBRA expired.
 
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