Tuesday, October 5, 2010


So, I take back my initial feelings about leaving the classroom. The more time I spend in the office of my school - right now I'm doing sort of double duty, teaching my assigned classes as well as helping in the office during my planning period and after students have left the building - the more I'm looking forward to not being in the classroom. I'm remembering all the reasons I enjoy being part of the school with out the encumbrance of being a teacher.

One thing I didn't count on was working through the benefits package I've been offered as a full time employee. On the outset, it seems great. $90 per month for family coverage? Holy shit. That's awesome.

Maybe I know too much. Maybe I don't know a good thing when it bites me in the ass (Mr. Rix could attest to that). I know enough to ask a crap ton of questions and that's where I got myself into trouble.

It all started when I got the initial information about the plan; $3M lifetime max and a 12 month waiting period for pre-existing conditions. I asked, then, how the recent healthcare reforms would change those to issues. The H.R. person suggested I contact Risk Benefit Management. For brevity, I'll refer to my Risk Benefit Management person as "A".

I emailed "A" to ask about the changes. At that point I was told that, yes, the policy would change and there will be no cap on the policy and no pre-existing clause for dependents 19 and under living at home.

I had also been told that the family premium for insurance would be $80 per month. With a $10 increase January 1st. As such, I emailed "A" to confirm that as of 1/1/11, the policy would no longer have a lifetime cap and pre-existing would go away at that time, as well. I learned that although the premium would increase on January 1, policy changes won't happen until July 1. So, we start paying more as of January 1st, but coverage doesn't change till July 1st.

At that time I was told that I would have a 12 month waiting period for any pre-existing condition during which time the policy may or may not pay $500 towards that condition.

This threw me for a loop...the pre-existing stuff. Granted, since I would have secondary coverage through my husband's policy it probably wouldn't matter, but there's the issue of the ICC policy preferring Methodist and my secondary coverage being OSF. My thyroid and apnea stuff aside, I still have hemophilia. I bleed here and there and haven't had to treat for my bleeding disorder. None the less, it chaps my hide that if I take the insurance (which I pretty much have to), it becomes my primary coverage. As such I will have a 12 month waiting period should I experience significant complications related to my bleeding disorder. Additionally, I might incur extra expenses because I choose OSF over Methodist.

And all this because this insurance opts out of HIPAA.

Which leads me to the NEXT issue. If a plan qualifies to opt out of HIPAA, employees are supposed to receive notification. Every year. Opting out has to occur annually. Opting out of HIPAA is supposed to be notified annually. Nowhere in any benefit stuff have I received notification that my prospective policy opts out.

And THAT leads me to my next issue...I'm, theoretically, opting in to an insurance policy that has opted out of HIPAA. What protections do I have with regards to my medical information? Sure, we all bemoan HIPAA regulations. I'm pretty much uncomfortable with an insurance policy that has opted out of the privacy protections of HIPAA.

"A" and I had some more correspondence during which she told me that although premiums were increasing as of January 1, 2011, plan changes won't take effect until July 1, 2011. When I asked why the different dates, "A" told me that during June employees can change their policy. (Most people refer to this time period as "open enrollment").

Mr. Rix and I mulled this stuff over...one thing we have been concerned with is that his employer has indicated that if there is an opportunity for secondary coverage and that coverage is turned down (like, if I chose NOT to take the ICC policy) there's chance we could incur a penalty. So, at this point we're trying to figure out the relationship between the penalty we'd incur and the cost of my new coverage.

We decide that maybe the way to go is for me to take individual coverage, see how it rolls and then pick up the kids and Mr. Rix (for secondary coverage) during the next open enrollment.

I email "A" again and ask a couple things: First, if I opt out of coverage now, when can I get back in; Next, if I choose single coverage, can I opt into family at that same time. And finally, since I have never had a lapse in coverage, doesn't HIPAA preclude the policy from imposing a pre-existing clause on me.

The bottom line is I either opt into the family plan or I'm fucked. Unless, of course, I have a qualifying event (divorce, death, unemployment)...then I MIGHT be able to get in.

Why do I have a feeling that even if some qualifying event came about, this insurance plan would find a mouse ass sized loophole to deny our coverage?

1 comment:

Miryam (mama o' the matrices) said...

oh, this plan really, really scares me. And has me wanting to go and check the new rules - aren't lifetime caps supposed to go away? And opting out of HIPAA? That's a new one for me, and I really don't like it. I agree: what kind of privacy would you get for your medical information?

Scary. How's it been with the plan?