For those with pre-existing conditions

**Jamauk** · 06-13-2008, 10:36 AM

I realize we need another post on this issue like we we need a hole in the head - however I wanted to make sure this didn't get lost in all of those pages and pages of debates....

My husband got his insurance liscense last year (no, he doesn't sell insurance), so I explained our whole debate (both sides) and asked his opinion.

He explained to me the whole "pre existing condition" thing and while it varies from state to state, here is the general law:

It is illegal to be excluded from health insurance for a preexisting condition under a group policy after x number of days under coverage.

In other words, in most states, if you have a serious condition and end up with a lapse of coverage, if you find yourself at another job where group insurance is offered (usually a business with more than 50 employees - again varies by state), after x number of days they are required to cover you.

Now, a lot of you will argue that because of peexisting conditions working full time is not always an option, and therefore ineligible for most group policies. Starbucks offeres full health benefits to their part time employees - so anyone lacking in coverage can go get a part time job at Starbucks and be fully covered after x number of day.

Because I've been thinking about Suki a lot lately and my heart has been breaking for her - I kept thinking there has to be a way. So looked up Arkansas insurance laws. From the document I found it seems that "group policy" is defined in Arkansas as 2 or more. It also states that preexisting conditions are to be covered after a 6 month lookback and a 12 month look forward (DH wasn't familiar with the term look forward, as we don't have that clause here in WA State).

http://insurance.arkansas.gov/consum...s_Brochure.pdf

This may or may not be an answer to some, but I just wanted to make sure this information was out there.

I AM NOT trying to reopen the great debate - I'll go to the other threads to carry on with that!

**suki** · 06-13-2008, 10:41 AM

Thanks for the info and for thinking of me. I appreciate it!

**Jskell911** · 06-15-2008, 09:12 PM

I'm sure your research will put a lot of people at ease. What a great thing for you to take the time to research it.

**Greebo** · 06-16-2008, 07:07 AM

Jamauk: You rock!

**Frugal Nurse** · 06-16-2008, 07:34 AM

Jamauk.. did you stay awake thinking of that?

You're so sweeeeeet!

Yep- I too feel terrible when a person can't get insurance coverage because they have a pre-existing condition.

90 days is generally the acceptable period of time. But I'm glad you did the research.

It will prompt people to do a bit of digging themselves. Don't accept what insurance companes/employers tell you all the time.
This is a sticky subject and I don't know if employers have to pay an increase in premiums if an employee uses the insurance a lot. (that wouldn't seem fair- but anything's possible) Would an employer - tell an employee that there is no insurance coverage because of XYZ? I imagine that would be illegal too.

There was someone on here who's spouse couldn't get insurance - seems that his employer was telling him that they might be cancelling insurance therefore no sense in joining. WRONG. Poor man had a known pre-existing condition.

I think if I look back, we might just find that the employer STILL has insurance.

Here's one I encountered last year. My youngest daughter who was 18 at the time, was working FT as a customer service rep at a shady internet company.
She was telling me how they were firing girls a lot there. Antenna up.
I'd inquire here and there about the situation and it seems that there is this 3 month review they all go through and the majority are let go.
I asked her how her boss thought she was as a worker. Seems that she was doing well, was told by her boss that her performance and telephone skills were as expected and was complemented several times.
THE BOMB: at three months she was 'let go'
What happened? she was told her skills weren't up to par.

I wanted her to pursue that but she was shy and being 18 now.. I couldn't interject.

What REALLY happened is ~ she would be eligible for benefits!

I asked her if she told them she didn't want insurance - she was still covered by my policy. She didn't.

What a pisser. I wondered if there was something I could have done. Me and my big ealthcare mouth. dammit! Where the ell is that H!?

**suki** · 06-16-2008, 08:39 AM

Originally Posted by Frugal Nurse

Jamauk.. did you stay awake thinking of that?

You're so sweeeeeet! yes, she is.

Yep- I too feel terrible when a person can't get insurance coverage because they have a pre-existing condition. Usually, the only option is employer based plans... but then, one must be healthy enough to work and qualify for them.
90 days is generally the acceptable period of time. But I'm glad you did the research. The 6 months/1 year is what gets us here in Arkansas. For the past 5 years, I've had flares that require treatment at least in a 3 - 6 month time frame... so I've never had a clear look back period. And, if I try to go for one... I get in trouble with my doc for not having periodic checkups... then if I have a flare, he's all grumpy-I-told-you-so doc.

It will prompt people to do a bit of digging themselves. Don't accept what insurance companes/employers tell you all the time. Personally, I never have... I've done the research and double checked it, more than once. I didn't want to be rude and tell her "I knew that already", when she obviously was giving it serious thought and working to be helpful. I would agree that everyone should dig deeper and learn the laws of their state for themselves rather than just accepting whatever they are told. I've found some very erroneous information perpetuated by folks who meant well, but never bothered to go to a reliable source and check the information themselves before passing it along as gospel.This is a sticky subject and I don't know if employers have to pay an increase in premiums if an employee uses the insurance a lot. (that wouldn't seem fair- but anything's possible)
That is exactly what happens and why group insurance isn't necessarily any less expensive than individual coverage. This is why some employer plans are so very expensive. Would an employer - tell an employee that there is no insurance coverage because of XYZ? I imagine that would be illegal too. That is illegal. They can't discriminate in that manner.
There was someone on here who's spouse couldn't get insurance - seems that his employer was telling him that they might be cancelling insurance therefore no sense in joining. WRONG. Poor man had a known pre-existing condition. I believe it would depend somewhat. Small employers are not required to offer insurance to employees, so if they choose to drop it... that's their right.

What REALLY happened is ~ she would be eligible for benefits! Far too common a practice.
What a pisser. I wondered if there was something I could have done. If she had documentation that her performance was good, she could have filed a claim with EEOC and they would have investigated the discrimination. FYI, they only take those claims for 6 months from the date of the offense. Me and my big ealthcare mouth. dammit! Where the ell is that H!? LOL!

Unfortunately, there's just not a simple solution out there right now. This is why we must have change.