"You don't have insurance now, then pre-existing conditions apply" ??? (employee, 2014)
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I have a new full time job, in a few months I'll have been there thru the probationary period and was looking forward to getting health insurance.
In the past (three years ago) I was self-employed and had private insurance. My business went bad b/c of the economy and about this time I had to cancel the insurance as I had a $5,000 yearly deductible and my savings were depleted. Every year it would go up even though I barely ever saw a doctor. It was basically catastrophic coverage.
I was able to find a PT job and was promoted to FT after 5 months but due to inconsistent hours I wasn't happy and started looking for a true FT job with guaranteed hours and benefits. (I wasn't at this company long enough as a FT'er to get the insurance and I didn't have any patience not working 40hrs/week after I'd been told I would , instead most weeks only getting 32 after having my hours cut so often as a PT'er)
I just spoke to someone at my current company (FT every week) and we were chatting about things. He asked me if I had a policy now and said "No". He then said, well "pre-existing conditions would apply"
I thought this was the one time you couldn't be denied insurance , ie. if you were getting it through your employer.
Now if I was to try and find private insurance again I understand I'd be subjected to a long battery of questions and likely a higher rate.
do I have per-existing conditions? well, I have nothing major wrong, nothing outside the norm but of course, everything really is a per-existing condition isn't it. There are plenty of people there who are FT and on the insurance that are not in great shape trust me. I'm in decent shape without any major problems.
I don't know if the reason he thinks I don't have a policy now is because I'm "un-insurable" but that's not why. I simply ran out of money with such a high deductible.
My question is can a company either deny you coverage or make you pay a higher rate b/c you don't already have an insurance policy?
I've never heard of this.
another question: can a company see how much you do to the doctor or how much health benefits you use? I've heard they can see how much the entire plan uses but can't see individuals unless there's been changes in the law.
just curious, I was very excited being gainfully employed, liking my job, feeling like I was on the path to recovery. And now this. Perhaps this was just a misunderstanding, the person that said this wasn't HR, they don't really have HR but a very important person at the company, like one of two individuals, so I'm a bit scared at what may happen over this.
There is no difference between insurance purchased through an employer and insurance purchased on the open market besides the fact that your employer is probably paying at least part of the premium. So, yes, existing conditions can be excluded. The guy you spoke to may have assumed that you didn't have insurance because of a preexisting condition and was just giving you a head's up based on his knowledge of the program.
If you don't have cancer, diabetes, problem knee, etc, you don't need to worry.
There is usually a clause in the insurance paperwork that will say the length of time that they will not cover any pre-existing conditions. You should ask about that. It doesn't sound like you are being denied this coverage.
Also, and I am not clear on the details (and NOT trying to spark a political debate) but I thought the HealthCare Act that was just upheld by the Supreme Court on Thursday had a section that made it illegal to deny coverage for pre-existing conditions?
Location: East of Seattle since 1992, 615' Elevation, Zone 8b - originally from SF Bay Area
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One reason people think that employer paid is without the pre-existing conditions issue is that mot larger employers have such a big pool they don't worry about it. For smaller employers or those with a history of large claims they have to be a lot more careful about it. The idea is to help keep the premiums lower for the employer and the employee contributions, and someone coming in with the need for a heart transplant or brain surgery will hit hard. Normally it will just be a waiting period, not a higher rate or denial of benefits. You have to check your state laws, since most of the federal changes are not yet in effect.
Most health insurance plans penalize people who have had a gap in insurance coverage. They do this by putting in the pre-existing conditions restrictions like the OP is referencing.
Most health insurance plans penalize people who have had a gap in insurance coverage. They do this by putting in the pre-existing conditions restrictions like the OP is referencing.
The difference is medium and large employers self-insure, and administrating insurer who has NO risk, is paid either per claim or based on dollars of claims paid. In such cases, if one is ruled out on a pre-existing, it is solely due to the employer setting the rule. The insurer, in a self insured setting, makes more money by covering everything under the sun.
Even in non self-insured, employers work with insurers to restrict stuff in order to get lower premiums.
So most often, when the insurer says "no" on the 800 number,folks fail to blame the right entity-their employer.
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