Pre-existing Come 2014

[Yagents]

That's just for 2014. Following years will be 1-2 month windows for open enrollment
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Would it be prudent to try to get this guy on a plan, even if he has exclusions for the hip, so he has a CCC six months down the road? It won't really matter in October for January GI enrollment though, right?

I suppose I'm asking for future reference as well. I'm certain some of us will come across clients with similar but different issues.

You won't need a CCC for Obamacare. Plus, you need 12 months of CCC coverage for it to be valid for the new insurance company. He should would want insurance, to have insurance for unknown items in the future.

Going back, if the group covers Pre-ex right away, then put him on the group. If not, get him declined by saying pending surgery on an IFP app, and put him on PCIP.gov now if no insurance for past 6 months (probably the best answer yet)

 

[taterpeeler]

I recommend that this prospect take the EMPLOYEE GROUP option if all of the following are true:
1. He really does marry the insured.
2. She gets the job she's applying for.
3. The Group's family coverage is effective relatively soon after hire.
4. The Out-of-Pocket is ultra low.

If any of the above are not true, he should:
1. Sign up for a Platinum Deluxe Obamacare policy when open enrollment arrives at his state exchange on October 1, 2013. 2. Once approved for the plan, he should schedule the surgery to happen as soon as possible after January 1, 2014.
3. When his operation and the ongoing therapy is behind him, your client could downgrade to a higher deductible, less expensive policy, if he wishes.

You'll likely receive additional input from other colleagues here on the forum, CTG. Digest it all and best of luck to you with your decision and soon-to-be client.
-Allen

omfg.... really? ...........ccc????
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That's just for 2014. Following years will be 1-2 month windows for open enrollment
- - - - - - - - - - - - - - - - - -


You won't need a CCC for Obamacare. Plus, you need 12 months of CCC coverage for it to be valid for the new insurance company. He should would want insurance, to have insurance for unknown items in the future.

Going back, if the group covers Pre-ex right away, then put him on the group. If not, get him declined by saying pending surgery on an IFP app, and put him on PCIP.gov now if no insurance for past 6 months (probably the best answer yet)

bingo and sti is selling them a denial letter on the local Austin street corner like the taco vender....

CCC, are u serious?

 

[somarco]

Personally, I wouldn't bet the farm on everything falling in place on 1/1/14. We are already seeing signs of deterioration on relatively minor things. Wouldn't surprise me a bit to see (at a minimum) a 6 month delay on the big stuff, such as GI.

I believe DC is running scared that the rates for GI will hit them like a load of bricks in an election year. The Dems OWN Alibamacare, and even though Hussein is not up for election there are a bunch of seats in the House that could be up for grabs and enough in the Senate to make a difference.

Nothing worse than voters carrying torches and pitchforks for a full 10+ months before an election.

 

[stuy119]

Personally, I wouldn't bet the farm on everything falling in place on 1/1/14. We are already seeing signs of deterioration on relatively minor things. Wouldn't surprise me a bit to see (at a minimum) a 6 month delay on the big stuff, such as GI.

I believe DC is running scared that the rates for GI will hit them like a load of bricks in an election year. The Dems OWN Alibamacare, and even though Hussein is not up for election there are a bunch of seats in the House that could be up for grabs and enough in the Senate to make a difference.

Nothing worse than voters carrying torches and pitchforks for a full 10+ months before an election.

Which will be interesting, because even if it's delayed a year, rates will still come out 30-40 days before the 2014 elections.

I can't imagine it gets delayed 6 months. There is no reason that plan year won't coincide with calendar year if they are putting this in place.

 

[Yagents]

Wouldn't it be worse if millions of his supporters don't get the free obamacare on time that they were promised 3 years ago?

The people with pitchforks are the ones that make money and will be paying through the nose for insurance, they didn't vote for him anyways (except those in hollywood)

 

[Ann H]

If he has been without coverage for at least 6 months, and is currently uninsurable in the IFP market (which he is), then he can get on PCIP and have his surgery.

Some group plans have no pre-ex waiting period, but they are rarer today than they were in years past. Most group plans have a 12 month waiting period for pre-ex, but they credit you month-to-month (or day-by-day) for prior creditable coverage, provided that you have not had a lapse of 63 days of more (not including the new-hire waiting period). Check with a local agent for any state alterations to that Federal Law.

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Since YAgents doesn't do group, let me correct some of his big huge errors.

CCC = certificate of creditable coverage. You get one when you come off of a real major medical policy. (He was right about this one)

CCCMM = certificate of creditable coverage Mini-Med. You get one when TaterPeeler has had enough and kicks you off

CCCNMM = certificate of creditable coverage Near Major Medical. You get one when HHS declares them dead in the water.

CCCOCI = certificate of creditable coverage Obama Care Implodes. You get one when this Titanic sinks.

 

[Yagents]

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Since YAgents doesn't do group, let me correct some of his big huge errors.

CCC = certificate of creditable coverage. You get one when you come off of a real major medical policy. (He was right about this one)

CCCMM = certificate of creditable coverage Mini-Med. You get one when TaterPeeler has had enough and kicks you off

CCCNMM = certificate of creditable coverage Near Major Medical. You get one when HHS declares them dead in the water.

CCCOCI = certificate of creditable coverage Obama Care Implodes. You get one when this Titanic sinks.

Ann, now that was funny! Look at you all loosey goosey

 

[Ann H]

Ann, now that was funny! Look at you all loosey goosey

Why not? I'm in the big club now, so I can pick a little fun with my friends can't I?

 

[Dave020]

Will pre-x be covered under Obamacare? In this specific instance, prospect does not have insurance currently. Most likely would be declined for individual because of an anticipated hip surgury. (resurfacing? He is from Minnesota-sounds like a Zamboni reference)

Will this procedure be covered if he waits until 2014?

Part B question: He's getting married in May and may be able to get on his wife's group plan if she takes a new job she's interviewing for this week. I'm not certain of the specifics of the new employers plan. Would this procedure be covered under her group plan?

Part C question: Can my Hawkeyes finish just one basketball game this season?

A. Yes, candidate for surgery is usually a decline.

B. If uninsured 6 months or longer, PCIP and stay on it until the end of the year. It will cover the surgery from day 1 and will likely cost less than the dependent premium on the group plan (which will impose a pre-ex waiting period without prior creditable coverage)

 

[VolAgent]

I thought most groups only applied pre-existing to people who didn't enroll in the group at their first opportunity? If you signed up as soon as eligible, either from hire, marriage or birth, then there was no pre-existing?