Talking over a cup of coffee, Mark explained that he lost his job a week ago. He had worked for a larger company and hopes to be re-called in 3 – 4 months, but some questions still remain. One of which is what health insurance options might he and his family have. While, his wife and two boys are in great health, Mark has had some ongoing heart issues. Being uninsured is not a good option. Mark’s question is: What options for health insurance will he and his family have?
Mark should receive from his company an option to continue his current insurance plan for 12 or 18 months (usually). Mark‘s company had well over 20 employees so they would have COBRA and usually 18 months of continuation (may be up to 36 months under certain circumstances). Under COBRA Mark would pay 100% to 102% of the insurance premium paid by his past employer.
In Mark’s case, it is advisable for him to continue with COBRA until it exhausts or he becomes covered under other group health coverage. If COBRA exhausts, Mark can move to Illinois HIPAA CHIP plan and have continuous coverage. Now, Mark’s family may have some other workable and less expensive options. They should gather information from an insurance broker for a health insurance plan which includes their providers in their network. They may be able to cut their premiums by as much 50%. Mark may stay with COBRA and his family secure individual coverage.
So what questions should Mark ask about this family coverage? First, make sure the premium works for him. Remember, higher deductible plans and less rich plans have a lower premium. Second, what exactly are the benefits? All plans offered must have an “outline of coverage”. Review this document for benefits, limitations and exclusions. Most importantly, ask and read about any “pre-existing condition limitation”. Some companies cover anything you have treated for within the past 12 months, after 12 months. This could be VERY important, and in Mark’s case his wife.
Under current law, insurance companies must cover children without pre-existing condition limitations, when applying with a parent. The premiums can be increased to cover an additional risk by the insurance company.
There are several other programs Mark may wish to research: AllKids and FamilyCare in Illinois may offer options for coverage. There are agents that represent AllKids (called AllKids agents) that can be a resource. The AllKids website is www.allkids.com.
For children through age 18 living in Illinois, who alone need health insurance, Blue Cross has a plan offered called “Blue Pathway”. This program is NOT available for children that have other major medical coverage available. While it is not available through agents, you can request that an insurance agent be named as your agent and information is available through www.bcbsil.com or Google “Blue Pathway Illinois”. It is always advisable to seek professional help with legal and financial issues such as insurance products.