Health Insurance in Tennessee (get credit, transfer to, buy)

[yeahiknowiam]

Hello all! My wife and I (ages 24 and 21) are moving to Nashville in a couple of weeks, and–among other things–I am trying to get a jump start on our health insurance. In Georgia, we have a wonderful, low cost, program called Tonik. However, it will not transfer to Tennessee with us.

I am getting insurance through my work, but does anyone have any suggestions for my wife? She has a DUI on her record, so it needs to be a company that either doesn't ask the question or doesn't deny coverage for the offense. I would really, really appreciate any help you could offer me.

All the best!

[insanesmooch]

Can't she get on your work insurance? I never knew that having a DUI would matter in getting health insurance. But then again, I've never known anyone personally enough who had a DUI to know that sort of thing. Though, maybe it differs from state to state.
When I got married, my husband added me to his work insurance and they didn't ask anything. I don't even recall them asking about pre-existing conditions, though I don't think they will cover them since most insurances don't.

[artemis]

I work for an insurance company, we write both Standard and non-Standard policies. If you can't get Standard (better rates), then non-standard will definitely take you. Be sure to shop with an independent agent, not a captive agent like Allstate, State Farm, etc.

If her DUI is more than 3 yrs old, it won't matter. My company doesn't go back more than 3 years on violations. (As do most companies)

[topropeprincess]

I agree with insanesmooch. Everywhere I have worked and insurance through my company, they have never asked any questions. Not even of me. They just sign you up. I have never even had any problem with pre existing conditions on a policy with my employer.

[InsuranceGuy]

Originally Posted by topropeprincess

I agree with insanesmooch. Everywhere I have worked and insurance through my company, they have never asked any questions. Not even of me. They just sign you up. I have never even had any problem with pre existing conditions on a policy with my employer.

You have not had any problems due to the kind of employer group policy you have entered and the fact that you have possibly had prior coverage that you received credit for. All plans have a 12 month pre-ex exclusion clause whether you have been called on it or not. To avoid the pre-ex clause, you now can leave one employer group and join a new one without pre-ex if you have what is called a letter of creditable coverage. This letter is generated by your former group insurance company upon your termination. It will show the start and term dates of your prior coverage. If the total coverage previously was 12 months...you get credit for that and now you have no pre-ex in your new plan. If there was 11 months of prior coverage then you went without for 1 month, you would get credit for 11 months and be subject to 1 month of pre-ex. [moderator cut]

[TriDad]

Originally Posted by yeahiknowiam

Hello all! My wife and I (ages 24 and 21) are moving to Nashville in a couple of weeks, and–among other things–I am trying to get a jump start on our health insurance. In Georgia, we have a wonderful, low cost, program called Tonik. However, it will not transfer to Tennessee with us.

I am getting insurance through my work, but does anyone have any suggestions for my wife? She has a DUI on her record, so it needs to be a company that either doesn't ask the question or doesn't deny coverage for the offense. I would really, really appreciate any help you could offer me.

All the best!

friend, Tonik is actually Blue Cross/Blue Shield. It originated in California when BC/BS decided to market to Generation Y and came up with a "cool" marketing campaign. Since Blue Cross is different in each state you will have to apply over again for her, but I do recommend you at least check out Blue Cross of TN. You should be able to call them directly and get answers.

The suggestion of adding dependent spouse coverage through your employer's coverage is a good one. At least find out the cost to add her, and then you can compare with individual options.

One last thing to consider....although group health coverage may cost more you may want to consider having it for both of you:

1) maternity should be included under your employer's policy whereas on an individual one it usually is not

2) guaranteed issue (you don't have to worry about her being turned down for any reason)

3) waiver of pre-X (if she has been treated for any medical conditions that require ongoing treatment and has had continuous coverage for at least 12 months on the Tonik policy and then doesn't have a gap of more than 63 days without coverage when you & her go on your employer's policy she'll get what's called a full takeover of benefits) [please note that the waiting period your employer may impose for new employees (ie..90 day wait) will not count towards the 63 day time test] (**this only applies when going from individual to group, or group to group..........not group to individual, or individual to individual [unless of course you get a letter of credible coverage and decide to convert to a HIPAA qualified individual plan {but that's a whole different ballgame there}]


hope that wasn't to confusing!
and yes...I am a licensed agent too

[topropeprincess]

Originally Posted by InsuranceGuy

You have not had any problems due to the kind of employer group policy you have entered and the fact that you have possibly had prior coverage that you received credit for. All plans have a 12 month pre-ex exclusion clause whether you have been called on it or not. To avoid the pre-ex clause, you now can leave one employer group and join a new one without pre-ex if you have what is called a letter of creditable coverage. This letter is generated by your former group insurance company upon your termination. It will show the start and term dates of your prior coverage. If the total coverage previously was 12 months...you get credit for that and now you have no pre-ex in your new plan. If there was 11 months of prior coverage then you went without for 1 month, you would get credit for 11 months and be subject to 1 month of pre-ex.

Well, I have to say that recently I went without insurance for about 4 months. I just started a new job and they signed me up no questions asked. They didn't even ask if I had previous coverage. I now have health insurance again. Based on what you said above, I should have a pre-existing clause. My employer tells me that I do not have one.

[TTLLKK]

I am not in TN. But now I have a similar situation. I and my son were covered by an individual insurance plan from Jan. to Apr. Now my new job will begin in mid-Aug. The insurance policy requires a letter of creditable coverage showing that the coverage break was less than 63 days. In my case, it has been more than 63 days. However, I can buy the individual plan for one month again and it can provide me such a letter. My question is that will the letter be good enough to exclude the pre-existing conditions for 6-months as specified in the new policy? Should I buy the individual policy now? Thanks a lot.

[TriDad]

TTLLKK,

If you don't have any major pre-existing conditions, then it shouldn't really matter. You'll still get coverage through your employer's plan whether you have the letter or not.

And if you think things through...you dropped your individual plan last April so if you pick another plan this month....you'll only get credit for this month...not going all the way back to January. So to answer your question...it will not waive the 6 month pre-X clause.

I do, however, recommend that you consider a short-term medical policy to cover you until your new employer plan coverage kicks in. This type of plan will cover you in the event something major and unexpectantly happens---like you wakeup in the Emergency Room or the back of an ambulance (this acutally happened to my friend last week---I just found out today)

Short-term medical (STM) policies are very affordable, and a good thing to have while waiting for your permanent coverage to kick in. PM me if you'd like more info.

[TriDad]

Originally Posted by topropeprincess

Well, I have to say that recently I went without insurance for about 4 months. I just started a new job and they signed me up no questions asked. They didn't even ask if I had previous coverage. I now have health insurance again. Based on what you said above, I should have a pre-existing clause. My employer tells me that I do not have one.

I hope you don't have one either. Know this...if a sizeable claim comes into the insurance company, they will "underwrite" you on the backend. In other words, they'll pull your records to determine whether or not it's a pre-X condition. For most people this is not a concern, but it's still important to understand what the insurance company rules, and applicable state and federal laws are.

In this arena, one can not address specifics without knowing more information. I'm painting an accurate, but broad picture here and will always tell people to seek the assistance of a licensed professional they trust.