Big Insurance UH-OH!

[Maestro]

Like sands through an hour glass....these are the days of my life...

Anyways...Another Uncle issue.  The insurance company he was on has gone under!  He is covered until the end of Feb.  He is a California resident (but was covered under a NY company because of business interests in NY).  The insurers in NY won't insure him being out of state under the business group policy.

So, I was told that since his insurance company has gone away, it is a law that ANY insurer must take him regardless of pre-existing conditions.  Is this true?  Hope so.  Also, if they DO have to take him, are they free to charge whatever?  It was fairly cheap before, but when the policy started, he did not have HIV.

Any help is GREATLY appreciated...

M

[AustinWesley]

Hey M,

Uh, I used to work for a health insurance co. in CA and that sounds partially true.   Is your uncle still employed?   How was he covered before?

One important item is to make sure there isn't a lapse in coverage.   Depending on the situation he may well qualify for a plan in CA, but they change the laws there more often than fashion.

If you can avoid a lapse in coverage do so at all costs.   I'd need more info. to go on, but you should be able to call carriers up and ask this question.   They will need the details, but stay on it if his cov. ends in Feb.

Best of luck,

Wesley

[Nico]

M,
I work in the field and am licensed in both NY and CA.  US insurers are not permitted by law to go bankrupt.  If they become insolvent, another carrier must accepts their risks.  As Wesley pointed out, there is consideration for continuity of coverage.

Is this a US based company?  Wesley may remember, but Confederated Life, who was a good size Life/Health carrier went bankrupt in the early 1990's, but was Canadian based.  Those folks were left out in the cold since this was not a US based company. 

I would suggest you or your uncle contact the Department of Insurance in NY and CA and see what your options are.  I think and hope your uncle will land on his feet and in good shape. 

Roger

[Maestro]

Austin,

He is not currently employed, but has the funds to pay for private insurance.  It's just a matter of will they insure him.  Please let me know what other info would help.  I am going to call some of the big insurance co's in the morning..

M

[Maestro]

M,
I work in the field and am licensed in both NY and CA.  US insurers are not permitted by law to go bankrupt.  If they become insolvent, another carrier must accepts their risks.  As Wesley pointed out, there is consideration for continuity of coverage.

Is this a US based company?  Wesley may remember, but Confederated Life, who was a good size Life/Health carrier went bankrupt in the early 1990's, but was Canadian based.  Those folks were left out in the cold since this was not a US based company. 

I would suggest you or your uncle contact the Department of Insurance in NY and CA and see what your options are.  I think and hope your uncle will land on his feet and in good shape. 

Roger

Roger,

He was with Horizon Healthcare.  Starting March 1 they have been absorbed by Blue Cross Blue Shield of NY.  Now, they did some fancy bookeeping to get him on the Horizon plan.  It is a family business based in NYC and he was added to the plan as someone who was working for the LLC.  When we called to enroll him with BCBS they said that in order to cover him, 50% of the employees would need to be NY based that are covered.  Well, there are zero NY based employees.  So he is out in CA and they said they won't cover him.  I guess this is some kind of rule to stop companies from enrolling distant relatives all over the country in a family business for insurance.  Not sure.  But I do that I need to find him some insurance before the end of the month.  How come I get the feeling that if I can get him private insurance, I can do anything? 

M

[Nico]

M,
I will PM you.

Roger

[AustinWesley]

Hey M,

I'm not trying to pry, but it sounds like he hasn't been working, but somehow still covered?   There are different laws relating to small business vs. larger corp.

You brought up an interesting point.   There are hundreds of thousands of people who don't work for companies who are listed as employees simply due to their relation to the owner etc.   but that is another topic

Huh, yeah I would agree with Roger's advice.    Definitely check with the carriers right away as well as the insurance commission if you can get them on the phone.

The biggest mistake you could make would be to let that insurance lapse (you don't want any gaps).

I'm unclear how he was covered to begin with, but I think I have an idea.

Wesley

[Nico]

Wesley,
I pretty much said in my IM what you did and made some suggestons.  I have been in the business (not sales) since I was 18 and it sucks to see people go through this type of hardship.

Roger

[Maestro]

Austin,

Exactly...not working, but still covered...I can break it down like this:  My blood Uncle was part owner of an apartment building.  His cousins are also owners.  They formed LLC for the building partnership and then the cousin runs the management company that runs the building.  So the insurance was through the management company and my blood Uncle was listed as an employee (though living in another state and not really working at all).  His partner (life, not business) was added to the insurance in the same fashion.  No employment at all, but 'snuck' in.  So it is the partner who I refer to as my Uncle and the one I am caring for now.

M

[AustinWesley]

Hey M,

My guess is that the carrier took one look at the claims and found the quickest way to rid themselves of this small business especially if they knew of 2 HIV+ individuals in such plan.   The risk ratio isn't profitable there and you bet they will find any way to get rid of businesses who are not profitable.

I'm not in the insurance racket anymore, but Roger could likely point you in the right direction more than I.

I wish you the best and holler if I can help further.

Wesley

[Boo Radley]

Although it sounds inapplicable to your uncle's situation, depending on the size of the company (20 or more employees) he might be eligible for continuation of health insurance via COBRA law(s), which dictates that an employee who leaves an employer can continue health coverage for 12 or more months at the group rate, not at a much higher individual rate.   After I lost my job in 2002 I stayed insured via COBRA and the state of Louisiana paid my $300+ monthly premiums to keep me off of Medicaid. 

Like I said, though, it doesn't sound strictly applicable because he was not a real employee but, hell, if the law might work to his benefit use it.  It stinks the company went belly-up on all of its participants in the first place.

If he is required to purchase individual coverage there will be a pretty hefty increase in premium.  If private coverage is not affordable some states have insurance pools for people with illnesses no insurer wants to cover, but that premium can be costly, too.  I assume he doesn't qualify for Medicare or Medicaid?  If there is an ASO in your area you might check with them about medical and social services your uncle might have available for no or low cost.

I don't mean to hijack the thread or antagonize anyone but this thread is another of too many reminders that health care is a basic human right. 

Best of luck to your uncle and you!

Boo

[Maestro]

Boo,

Thanks for the info.  The 'company' only had 3 (fake) employees...It was a nice run while it lasted!  Anyways, he can afford just about any insurance premium...but can he get it is the question.  And he does not qualify for any medicare/caid...In fact, he has worked so little in his 51 years that he cannot even qualify for disability!  He has put almost nothing in to the SS system. 

I am in Florida and he is in California.  I am going to call a few insurance brokers out in CA.  If they don't hang up the second I say he has HIV maybe I can make some progress!

M

[AustinWesley]

Hey M,

Yes, if he can pay almost any premium then he should be able to get a private policy.   The cost will be high, but he should be able to.

Cobra usually is only going to last for up to 18 months typically, but even with that you want to make sure you don't have gaps after.

Wesley

[Boo Radley]

  Anyways, he can afford just about any insurance premium...but can he get it is the question. 

Maestro,

Like Wesley said, if he can afford the premium he'll be able to find an insurer but the monthly premiums will be outrageously high.  Since he's in CA I'd think his chances of finding a high-risk insurance pool would be pretty good.  Even though such a pool's premiums are high they should be somewhat lower than an individual policy. 

Good luck!  I wish I had an advocate like you working for me!

Boo