Tuesday, July 22, 2008


I'm closely watching The Health Insurance Coverage Protection Act

In a nutshell, this act would limit limits imposed by health insurance companies via lifetime caps. Currently many insurance companies impose a lifetime "cap" in the amount of medical payments they will provide. Most often it's $2M. Unfortunately, $2M doesn't get you very far in medical dollars these days. It is quite common to cap out a policy in one year should you or a family member suffer serious injury or disease. And not just freak accidents, either.

Caps were "established"/"invented" back in the 70's and a $1M cap wasn't the chump change it is now. That equals roughly $10M with the economy in the recession economic down turn , correction, SHITTER like it is today. The caps have never adjusted for inflation or rising medical costs. This bill would help by requiring that companies raise caps and then adjust for inflation annually. Info and links are towards the bottom.

My kids' drugs cost about $200K per year and the bigger they get, the more it costs. So, with a $2M cap, you can see that they'd easily cap out right about the time they were leaving for college...if not sooner. Insurance companies can institute a cap at anytime. The cap won't take affect till after the 1st of the year, but you could go from NO lifetime cap to a $2 lifetime cap in the course of a year. Which is what happened to us. Same organization for 10 years. 9 years no cap...year 10, January 1st, $2M cap.

When my husband asked Human Resources what was planned for employees who capped out. The lady said "Oh, I don't know, no one ever reaches a cap." That's when we knew we'd need to find another way. So we moved here.

But now our insurance provider (OSF HealthPlans) has been purchased by Humana. We will learn in October what changes, if any, there will be to our current coverage. Chances are pretty good that nothing drastic will happen this year. However, we are prepared to find that our NO cap policy will go to a $2M policy within a couple years. We moved back to Illinois because this state has a much better safety net for our children should we have that nasty cap thing happen. The boys have something to fall back on once they are going to college. There primary focus at that time should be college or whatever it is they want to do....not worrying about their medication.

Even they understand the importance of insurance...one of 'em told me he was going to be a Rock Star...but only at night because he's also going to be a doctor during the day, so he has good insurance. And the other one wants us all to move to Canada.

So, the first request is to find out what your own family/individual's lifetime benefits cap is. You can find that info from your Certificate of Coverage (you should get a new one every year from your provider...call and ask for one).

HERE is a link I received today from the National Hemophilia Foundation. The information about the legislation makes mention of bleeding disorders as an example of a condition that suffers greatly under the current system. This is a link to send a letter to your senator via the National Hemophilia Foundation and THIS is for your congressperson. Or do it your own way.

So, take a sec, check the links and thanks for listening.


Anonymous said...

My cap? My monthly pay.

Jennifer said...

I went to the three links. Thanks. And, yes, I will check our cap. The $2 million is sounding familiar... so I'm thinking that is probably our CAP. One of those things, in looking over the insurance, I eyeballed, then moved on, not thinking enough about it's impact.