- 3,863
You sure about GR? I don't think so.
Pre-existing conditions and individual health
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Regarding GR - check page 13 of the brochure:
This exclusion will not apply to conditions that are both: (a) fully disclosed to GR in the application: and (b) not exlcluded or limited by our underwriters.
THis is the SC version of course. Could be different in other states.
This exclusion will not apply to conditions that are both: (a) fully disclosed to GR in the application: and (b) not exlcluded or limited by our underwriters.
THis is the SC version of course. Could be different in other states.
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I have a hard time with this one, Company A brochure, in MI, does not mention prior creditable coverage. It just states that whatever you have been treated for in the last 6 months is not covered for 12 months. So in essence you could have the Blues for 20 years and pre-x still applies.
Cmpany B pre-x applies if you came from an individual plan, or didn't exhaust COBRA.
Are there no federal standards for Prior Creditable coverage?
Love to hear from the veterans.
Cmpany B pre-x applies if you came from an individual plan, or didn't exhaust COBRA.
Are there no federal standards for Prior Creditable coverage?
Love to hear from the veterans.
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Re: pre existing conditions and individual health
You asked the correct question: however the term is "creditable" not "credible". The definition is important. What you are looking for is "credit" for prior coverage. This will vary from carrier to carrier and is under guidance from your state DOI.
I serve Kansas and Missouri, so I don't know your state laws, but several others have given you good advice on this subject. Just be aware, some advice on this forum may be well-meaning but inaccurate. Therefore I am reluctant to say anymore than to be careful... "creditable" rules differ for individual insurance policies versus group insurance policies.
Example: Group insurance regulations (at least in Kansas) have different maximums on pre-existing conditions depending on the size (# employees). Prior "Creditable" coverage cannot be transferred directly from previous group coverage to individual policies without going through the high risk pool first. These rules may be different in SC.
I am not trying to confuse you, just make you aware that there are a lot of variations in rules regarding pre-existing conditions and prior creditable coverage. State laws, type of policy (group or individual), and carrier policy guidelines differ. A licensed, and qualified state agent should know.
Last comment: Migraines are not necessarily symptomatic, they may be a disease. When I studied this phenomena in school, it was thought that the pain of migraine stemmed from dilation of blood vessels between the scalp and the cranium, and therapy was designed to constrict blood flow in these vessels, etiology mainly unknown. Tension headaches were relegated to muscle spasms brought on by stress and could be relieved simply with stress reduction and/or analgesics such as aspirin. No one really knew the reason for migraines, and remedies used for tension did not effect migraine, hence my investigational study. There seemed to be a genetic predisposition to migraines, and some migraines may have an established etiology, but others remain a mystery. This info is quite dated (30 years old), and is not qualified medical advice. Ask your wife's doctor for the latest.
You asked the correct question: however the term is "creditable" not "credible". The definition is important. What you are looking for is "credit" for prior coverage. This will vary from carrier to carrier and is under guidance from your state DOI.
I serve Kansas and Missouri, so I don't know your state laws, but several others have given you good advice on this subject. Just be aware, some advice on this forum may be well-meaning but inaccurate. Therefore I am reluctant to say anymore than to be careful... "creditable" rules differ for individual insurance policies versus group insurance policies.
Example: Group insurance regulations (at least in Kansas) have different maximums on pre-existing conditions depending on the size (# employees). Prior "Creditable" coverage cannot be transferred directly from previous group coverage to individual policies without going through the high risk pool first. These rules may be different in SC.
I am not trying to confuse you, just make you aware that there are a lot of variations in rules regarding pre-existing conditions and prior creditable coverage. State laws, type of policy (group or individual), and carrier policy guidelines differ. A licensed, and qualified state agent should know.
Last comment: Migraines are not necessarily symptomatic, they may be a disease. When I studied this phenomena in school, it was thought that the pain of migraine stemmed from dilation of blood vessels between the scalp and the cranium, and therapy was designed to constrict blood flow in these vessels, etiology mainly unknown. Tension headaches were relegated to muscle spasms brought on by stress and could be relieved simply with stress reduction and/or analgesics such as aspirin. No one really knew the reason for migraines, and remedies used for tension did not effect migraine, hence my investigational study. There seemed to be a genetic predisposition to migraines, and some migraines may have an established etiology, but others remain a mystery. This info is quite dated (30 years old), and is not qualified medical advice. Ask your wife's doctor for the latest.
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See my other post about this. Federal standards eminate from HIPPA, and apply to group policies, and vary with self funded or fully funded plans which are then modified by state regulations. In my limited knowledge, individual plans have no federal regulations in this matter, and are regulated by the state DOI which may have more relaxed rules... I really don't know because I am only licensed in two states. It appears to me that competition would be the driving factor for what a carrier will or will not provide regarding individual pre-ex rules (subject to state law).
HIPAA is indeed a federal law and applies to all group plans regardless of the funding mechanism. The states are allowed to establish their own HIPAA-like rules as long as they are equal to or less stringent than federal law.
Self funded plans follow ERISA guidelines and are exempt from state mandates but not federal law.
Thanks for pointing this out. I should have been a little more explicit about the details.... I was making a quick point, not a lesson.
- 3,863
I don't mean to be the spelling police... but...
HIPPA - Privacy
HIPAA - Portability
I am assuming this thread is talking about HIPAA not HIPPA.
As previously stated HIPAA is RELATED TO GROUP. On Individual this is determined on a state by state basis and or carrier by carrier basis.
Consumers are completely confused by HIPAA in the individual market.
Side note - here in Texas all carriers must accept prior group or individual (even short term) as creditable. However plans are still underwritten and can rate up, decline or waiver forever.
Try explaining to a consumer that the 12 month pre ex is worthless if waivered / ridered. You get a lot of arm chair attorneys researching HIPAA on the web.
HIPPA - Privacy
HIPAA - Portability
I am assuming this thread is talking about HIPAA not HIPPA.
As previously stated HIPAA is RELATED TO GROUP. On Individual this is determined on a state by state basis and or carrier by carrier basis.
Consumers are completely confused by HIPAA in the individual market.
Side note - here in Texas all carriers must accept prior group or individual (even short term) as creditable. However plans are still underwritten and can rate up, decline or waiver forever.
Try explaining to a consumer that the 12 month pre ex is worthless if waivered / ridered. You get a lot of arm chair attorneys researching HIPAA on the web.
I have never heard of HIPPA (although I have put too many "P's" and not enough "A's" in responses at times in haste).
Can you reference a source for HIPPA?
HIPAA (Health Insurance Portability & Accountability Act) was originally passed in 1996. It has been implemented in stages as well as amended.
PHI (Protected Health Information) is part of HIPAA and was implemented in 2003 in part with full implementation by 2005.
Can you reference a source for HIPPA?
HIPAA (Health Insurance Portability & Accountability Act) was originally passed in 1996. It has been implemented in stages as well as amended.
PHI (Protected Health Information) is part of HIPAA and was implemented in 2003 in part with full implementation by 2005.
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