aurigus

I'm looking for some insurance advice for anyone that knows about it or has been in a similar situation.

Basically I've been at this job for 2 years and I've determined to leave it soon. I'm going to work for another guy in web hosting, but he does not have an official company, and no insurance.

So what I need to do is to get on another insurance plan. I called my current provider, and they said that I have COBRA coverage under the plan I have now, I believe that means I can continue paying on my same plan for 6 months with the same coverage.

Here is the tricky part - my wife and I are trying to get pregnant (well, you know what I mean) - so that throws a kink into the situation. Some insurance plans do not cover pre-existing conditions (like pregnancy), and I would like to avoid getting stuck with the hospital bill for that.

So, is it possible to get insurance directly through my existing company (Aetna)? I went through a price quote on their system and I can get an decent HMO for about the same I am paying now. I have a number I'm supposed to call to get information but would like to get all of the info I can to make sure I'm not raped on prices. I'm expecting to pay around $500 a month, that seems reasonable from what I have heard.

Any thoughts or suggestions? Thanks

MSD

I pay just under $200 per month for individual coverage under Anthem Blue Cross/Blue Shield. I'm not sure, but I think being a college student who lives at home brings the cost down a bit. On the other hand, my mother has a cobra plan and pays something like 750 a month. You may want to get individual insurance for you and your wife because it'll probably be cheaper, and you cut out the middleman.

maleficent

From what I remember, if you are young and healthy, COBRA isn't that great a deal, it gives you uninterrupted coverage, but that's about it.

Just as an FYI -
http://insurance.yahoo.com/lh/pregnancy.hin.html
From what I can gather, HIPAA only applies going from Group to Group plan. Group to Individual, there might be loopholes (I've been looking about 5 10 minutes, and have found about 15 different answers)

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aurigus

Thanks for your advice - I have come across that problem as well. Most of the information I have found is from sites trying to sell their own products, so I don't trust that information at all.

Cynthetiq

COBRA is not cheap and it's not cheap when you have a family.

IMO that your friend who doesn't even have a company...puts your family in some jeopardy since you'll have to cover your costs for COBRA or any other plan. Individual family plans are very expensive.

Why not keep the job you have, do double duty helping your friend where you can at least until after the baby is born. You'll at least be out of most of the woods by that time... also you'll know if you're new adventure would truly bring home more than just the bacon.

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aurigus

I've truly considered that, it isn't really a new venture and has been established for 4 years now, I could probably go on a whole other thread about that part and the backstory of why I am moving

I just checked ehealthinsurance.com, they are quoting around $230 - $260 for the HMO plan I am looking at, I don't know if I believe that or not but it seems like a decent deal. I'm sure it doesnt have the coverage that we have right now but it would be fine, we are 2 healthy young people - I know that can change in the blink of an eye, but that is the whole reason for health insurance. It's just a play on the odds. Plus $22 for a dental rider (minimal).

Caveat - on the application it lists the requirements, one is: Not pregnant at the time of application submission.

That is a tricky statement, what if I apply today and find out she is actually 1 month pregnant.... that would certainly bite

I feel like those 2 commercials, the one about the pregnancy test and making important decisions, and the one with the guy shaking his head in confusion at health insurance plans.

Mikado

I'm a group health broker in Houston, so maybe I can lend some insight into the situation. Notice though that things can change from state to state. Insurance is state regulated so law and provisions may be different where you live.

When I have a client in your situation I ALWAYS recommend staying with COBRA. Now the rules in Texas state that a company with 20+ employees falls under COBRA, and less than 20 falls under State Continuation. The difference? Under COBRA you can continue coverage for up to 18 months as long as you pay the full premium. State Continuation only provides 6 months of coverage. The reason I suggest people stay with COBRA is because in Texas, individual insurance DOES NOT cover maternity. So if your wife is pregnant, you'll be paying for insurance and the entire cost of the baby's birth. Not a very good deal, when you could have continued to pay your COBRA premium and had the entire thing covered. Of course the exception would be if you only have 6 months left out of 18, and the baby's not due for 8 months.

Now if your new boss were to look into some group health insurance, his rates would be 67% higher than standard issue because of your wife's pregnancy. So more than likely that is out of the question. If you can find an individual policy in your area that DOES cover maternity, then your rates will also be raised. How much depends on the state's regulations. Like the previous example, in Texas providers can only raise rates to a maximum of 67%. The other thing to take into consideration with individual plans that DO cover maternity, is that they will consider it a pre-existing condition and may decide to exclude it from coverage.

Unfortunately individual insurance (in Texas at least) doesn't cover everything that group insurance does. The rates aren't that much lower either, so if it all possible stick with a job that provides some group coverage. There are plans out there for small businesses to help them provide benefits. In Texas a group is only required to have 2 full time employees. However proper tax documentation has to be provided to show an employer/employee relationshiop. It's there to prevent a husband/wife getting group insurance.

If you have any other questions, let me know and I'll do my best to answer them. But again let me state that if you're outside of Texas, laws and regulations set by your state could be quite different. Good luck to you!

aurigus

Mikado and all -

First of all thanks for your advice.

Fortunately we are not pregnant yet so there is a bit of a choice. It sounds like it might be good to stay on Cobra till the pregnancy is over (if she conceives soon) - but if I can save money might just move to an individual health plan. The ones I have been reading, that are specifically for Pennsylvania, cover maternity and the only fees I see is a $200/day fee for delivery.

One of the things I've seen also say they only cover maternity if you've been on the plan for 12 months. I've been on the group plan for that long, I dont know if they will roll it over to a new one.

Mikado

Probably the best advice I can give you Aurigus, is to find an independent broker/agent. That's what I am. Basically that means the broker can sell any insurance provider he is appointed with. For instance I'm appointed with United Healthcare, Humana, Aetna, Blue Cross/Blue Shield, and GE Financial. I don't work for one particular provider, so I'm not going to push one over another. I have the ability to quote several plans from several carriers and find one that suits you and your situation. If you use an agent that works directly for one particular carrier, he's going to try to sell you the plan that brings him the most commission. I get paid reguardless of which carrier you go through, so I'll help get you enrolled according to your best interests.

pook

I think this is great advice. If your wife gets pregnant within the next few months and she delivers nine months after that, you're stuck in the old job for only a year, or maybe a bit more just until you're sure the baby is healthy. Meanwhile you can freelance for your buddy on nights and weekends. This will also give you the chance to see what it's like working for him.

The current job may not be what you want for the rest of your life, but with a freelance gig on the side at least you'll have the option of telling the current employer to kiss off if things get really bad.

JaySpencer

Have you checked locally to see what the laws are in your area? I hat to invoke the name of "lawyer" but you may want to consider calling one, as it may be worth paying their fee even for 30 minutes of their time, alternativly, as Mikado suggested check with brokers to see what they have to offer, and what they can tell you about the laws. I was under the impression that pregnancy was not considered to be pre-existing, that all insurance had to allow for it, but I could be wrong, the laws may have changed since what I knew, or it may be a local thing in my area.