Should This Person Keep Her IFP?

Franz Kafka

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Here's the situation. 11 employee S-corp is starting a virgin group. Both owners will have to join in order to hit the required participation. One of the owners' wife is 2 month pregnant. I'm thinking she should keep her current IFP until the baby arrives and keep the future group rate down especially considering how one of the employees already has a pre-ex condition (kidney stone). I figure she's been paying high premium toward her IFP so why not use it before she joins her husband's group policy? Am I thinking this right?? I'm in CA and still learning health.
 
Maternity always increases the RAF on a group. I have one group that had 3 babies in one year and went from 0.97 back up to 1.08.

11 person groups can get good RAFs if the overall health is a good risk. Add her in and it will most likely increase the final RAF for that group.

Your thinking is sound on this since she already has an IFP plan to cover this pregnancy.
 
Dave gave good advice. You might also look at it from the woman's point of view. First, I assume you made sure she HAS a plan now that covers maternity. In CA, most IFP carriers only have 2 or 3 "affordable" PPO plans that do (except Aetna which has none TTBOMK). HMO plans cover mat but those are pricey in CA.

Anthem lets an IFP subscriber with a non-mat plan switch to a $5,000 deduct (I think) mat. plan without UW because they know that an average 24-48 hour delivery/hospital stay runs just about that amount give or take a few dollars, so there is no big risk for them. Shield has a similar policy.

So, compare coverages and deducts with her current IFP plan vs. what she can get with whatever group plans you are considering. All CA group plans offer maternity so she will have a wide choice.

You also want to check the pre-ex rules for the group carrier you are considering. Here is the excerpt from the Anthem Blue Cross of CA UW guidebook, page 11:

25. Pre-existing conditions

a. Pre-existing condition limitations are currently imposed,
where applicable, for up to 6 months following the
effective date of coverage and are applied to conditions
for which care was sought or provided within 6 months of
the enrollment date. Pre-existing condition limitations are
not applicable to newborns and adoptees. Pregnancy is
not subject to any pre-existing condition limitations.
Note: The “look back” period for pre-existing conditions
begins with the enrollment date (usually the hire date, not
the effective date).

b. Anthem Blue Cross will give credit for prior medical
or dental coverage (including Individual, Group or
State- Sponsored Programs) in accordance with Health
Insurance Portablity Assurance Act and AB1672.
(Verifi cation is required.)

c. Anthem Blue Cross HMO has no pre-existing
condition limitations.

d. New hires, re-enrollees and late enrollees could be
subject to the pre-existing clause as stated above.
any applicable pre-existing conditions limitation (giving
credit for prior coverage as required by law).

Hope this helps.

(I'm partial to Anthem, especially for virgin groups.)

And by the way, it is Dave020 who taught me all of this stuff over the past 4+ years. Dave is THE KING of CA IFP/group health insurance. (The title of KING of Calif. Medicare is held by Rick B (aka greensky)) If Dave (or Rick with Mcare) does not know it, no one knows it. If you want the right answer, Dave is the go-to guy for this group/IFP stuff.

(An guys, please... even though I live close to San Francisco, I am NOT the QUEEN! Sorry to disappoint.) :D :D
 
Thanks guys. I agree with you, Al, about Dave. He's really the one who got me started in the health business.
I found out she could actually get a better coverage for her maternity expenses under the group for the same dollar amount the family's paying now. So the current dilemma is whether to pay the higher deductible under her IFP and keep the future group rate down or just use the group for the better coverage now and deal with the rate later.
The employee with the kidney stone can get HMO and not be affected by pre-ex I believe.
 
I'd make a call to underwriting and find out what they ballpark the RAF effect to be on this group. If it's negligible, say 1 or 2 points, then it might be fine to go ahead and move her over. If the hit is bigger, then you'd need to think about that.
 

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