Mega Healthcare...creditable Coverage?

[jimsthename]

Health Insurance pros...I need your help (I'm an agent, but I don't specialize in health insurance)

I have Crohn's Disease and recently applied to Illinois "Pre-existing Condition Health Insurance Plan (IPXP)" and was DENIED coverage.

The reason I was denied was because they determined that I currently have "creditable" coverage based on my current plan with MEGA Healthcare. Of course, I was denied by several bonafide universal carriers (e.g. Unicare, BCBS, Celtic and Assurant) and took the plan with Mega as an only resort. Mega has excluded my Crohn's Disease from coverage.

I do not consider my MEGA plan to be "creditable" coverage and am seeking the industry correct terminology to convince the Illinois underwriter of this.

Can you help me?. Thanks.

 

[Crabcake Johnny]

Back when I was selling Mega, even though the plans were limited, it was indeed creditable coverage.

 

[gmhopks]

Back when I was selling Mega, even though the plans were limited, it was indeed creditable coverage.

Please provide a definition for the term 'creditable coverage'.

Obviously, I am new to the insurance industry and trying to learn terminology, concepts, etc.

Thanks

 

[Crabcake Johnny]

I'm not sure there's a pure definition. If Mega issues a certificate and Illinois accepts it then it's game, set and match.

 

[DS4]

Most health coverage is creditable coverage, including prior coverage under:

• a group health plan (including a governmental or church plan)
• health insurance coverage (either group or individual)
• Medicare
• Medicaid
• military-sponsored health care program such as CHAMPUS
• a program of the Indian Health Service
• a State high risk pool
• the Federal Employees Health Benefit Program
• a public health plan established or maintained by a State or local government and
• a health benefit plan provided for Peace Corps members.

Mega, even though it has limited benefits, would fall under bullet #2.

 

[dgoldenz]

Wouldn't this depend on whether it is a limited benefit plan or a plan that caps OOP expenses? From what I have seen, I believe MEGA had policies that did both. I would think the plans that cap expenses would be creditable coverage and the limited benefit plans wouldn't. Yes? No? Good question, nobody ever seems to have a definitive answers....I suppose you could call MEGA and ask for a certificate of creditable coverage. If they can't give you one, you have your answer.

 

[somarco]

What is and is not creditable coverage is left to the carrier (or in this case, PCIP/IPXP) to decide. I am aware of carriers that approved AIM as creditable coverage while others considered it a joke (which is more accurate).

you could call MEGA and ask for a certificate of creditable coverage. If they can't give you one, you have your answer.

Not necessarily. See above.

 

[jimsthename]

Thank you all.

Called carrier and appears it is creditable.

Next stop...letter to state senator on the irony of personally having a preexisting condition, yet being denied coverage to a plan called "Preexisting Condition Health Insurance.

Thanks again

 

[dgoldenz]

Thank you all.

Called carrier and appears it is creditable.

Next stop...letter to state senator on the irony of personally having a preexisting condition, yet being denied coverage to a plan called "Preexisting Condition Health Insurance.

Thanks again

Ironic isn't it....they should call it the "you're screwed if you have current coverage no matter how bad it is health insurance plan." Perhaps that would describe it a bit better for your average person.

 

[Norwayguy]

Thank you all.

Called carrier and appears it is creditable.

Next stop...letter to state senator on the irony of personally having a preexisting condition, yet being denied coverage to a plan called "Preexisting Condition Health Insurance.

Thanks again

Your missing the point of this program...It is for people that do not have and can not get coverage....I pointed out the crazyiness of a person that is responsible and took out a policy years ago and say was rate up and is paying much more than the Standard rate but is covered and someone that was not responsible and didn't carry coverage and now is uninsurable and now signs on with PCIP plan in their state and pays less than the person that was responsible and this person because they have coverage can not qualify for this new coverage.....I'm sure this program is helping some people that needed a plan like this but I think its more likely that many people here turned down opportunities for coverage before they were uninsurable and now want someone else to bale them out of trouble now that their gamble is not paying off......I'll get off my soap box now.