Getting my own insurance?

Melanie B.
on 7/23/07 4:41 am - Doylestown, PA
So stinkin' United Heathcare and my employers are of no help whatsoever. I have an exclusion in my UHC policy for WLS period. I have just applied for Independence Blue Cross HMO @ $287 p/mo for an individual plan. I am waiting to see if I will be approved. It lists under "What is not covered"  "Treatment of obestiy, except for surgical treatment of morbid obesity when medically nessecary" It also seems to have a pre-existing condition clause of 90 days. However, since my PCP and I have only talked about the possibility of me looking into WLS, is jsut the fact that I'm obese a pre-exisiting based on my BMI? I would think that if this was the solution everyone would be doing it...and since I cant' find anything on OH that says they have, I'm worried I'm barking up the wrong tree. Anyone have experience with this?
.::Princess
Nutmeg::.

on 7/26/07 10:54 am, edited 7/26/07 10:54 am - Rohnert Park, CA
From http://www.pacode.com/secure/data/031/chapter151/s151.9.html  (d)  Pre-existing conditions. If pre-existing conditions are excluded, or limited as to coverage, from the medical care and services available from the provider, whether or not available at an additional charge, the term pre-existing conditioning shall not limit coverage beyond that stated in the following definition: ‘‘A pre-existing condition is a disease, illness, sickness or physical condition for which medical care, advice or treatment was recommended by or received from a physician within the 5 year period preceding the date of admission to a facility.’’ From http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html "HIPAA contains protections both for health coverage offered in connection with employment (group health plans) and for individual insurance policies sold by insurance companies (individual policies)."

If you choose to apply for an individual policy for yourself or your family, HIPAA includes protections for individual policies that:

  • Guarantee access to individual policies for people who qualify

  • Guarantee renewability of individual policies"

From your Department of Insurance in Penn. Guaranteed Issue of Health Insurance to Eligible Individuals. New Pennsylvania law also makes it easier for you to get individual insurance under certain situations, including if you left a job where you had group health insurance, or had another plan for more than 18 months without a break of more than 63 days. Specifically, if you meet certain criteria, you are considered an eligible individual and guaranteed the right to buy individual health coverage from Blue Cross and Blue Shield plans in Pennsylvania without a pre-existing condition exclusion period. To be an eligible individual, you must: 1) have had 18 months of continuous credible coverage, at least the last day of which was under a group health plan; 2) have used up any COBRA continuation coverage for which you were eligible; 3) not be eligible for Medicare, Medicaid or a group health plan; 4) not have other health insurance. You must apply for health insurance for which you are an eligible individual within 63 days of losing your prior coverage.
(Hi/DoS/CW/GW) 335/320/243.5/174  (-91.5)(total lost) in 18-20 dependent on brand!
I'm more than half-way there! :) (68.5 pounds to go)
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