CalBear

Gruppe:

I switched jobs a couple of months ago and have already been covered by my new job's health plan. However, there was a month where I didn't have any coverage between my last job's health care provider and the current health care provider (same company). Even though the gap period has come and gone, I just got paperwork to enroll for COBRA on that one month. My question is- if I didn't go to the doctor or filed any claims, do I need to get COBRA for that one month gap? My only concern is that some day my insurance company would refuse to pay for something and use this gap of coverage as a reason. For example, if I had an arm injury that required medical treatment and a year from now I need treatment for the same injury, can my insurance company deny coverage? I called my insurance company today and they told me that my new policy does not have a "pre-existing condition clause" so it appears that I'm okay without having to pay and get COBRA. However, I just want to make sure. I'd appreciate your thoughts. Thanks.

ralper

I'm certainly not an expert on this, but my understanding is that any condition that arises while you are covered by your current policy should be covered whether or not there was a gap in your coverage. I have heard that a gap in coverage extends the period needed to wait for new coverage by some companies, but this apparently has had no effect on you.

canberra

Don't want to call myself an 'expert' either, but I have been kicking around in the insurance industry for a few years now.

If there was only a 1 month break between the end of the 'old' group plan, and the beginning of the 'current' group plan, you should not have to exercise the C.O.B.R.A. option from your previous employer (unless, of course, something happened during that month that you want to claim).

The other law that comes into play here is the health care portability law (HIPAA), which basically says as long as there is no more than a 60-day break without credible coverage between the end of coverage under your 'old' group plan, and the beginning of the 'current' group plan, your current insurer has to use the time you were covered under the 'old' plan as a credit against any pre-existing waiting period that might normally be required under the 'current' group plan. In other words, if you were covered under the 'old' plan for 3 years, and the 'current' plan has a 12 month pre-existing condition exclusionary period.... the 3 years of previous coverage would more than wipe out that 12 month exclusionary period.

You may have to provide the 'current' plan administrator (even if it is underwrittten by the same insurer) with a "letter of credible coverage" from your previous employer plan. The HR department with your prior employer should be quite familiar with this.

There may have been some more recent "fine tuning" of both COBRA and HIPAA requirements (seems that they never quite leave these things alone), but to my knowledge the basic nuts & bolts provisions are as outlined above.

By the way, if it has been a "couple of months" since you switched jobs, your prior employer is notably behind the time line for sending you COBRA information.... that should have been done when your 'old' coverage was terminated.

Lainey

If you are CERTAIN there is no pre-existing condition clause with your new insurance you may not need COBRA.

I'm no expert, but I've been led to believe that any lapse in coverage is not a good thing.

My niece had a two week lapse in her coverage and her new insurance company refused to pay for her blood pressure meds until she had been on the new plan for 12 months as it was a "pre-existing" condition.