April 2013 Moms

Advice on Insurance Issue

Another good first world problem to have: My husband and I got married last year. Since we both had insurance through our employers (he pays a percentage of each paycheck and I don't pay anything) we decided to just stick with our own plans. Along comes baby and after weighing the pros and cons, we've decided I need to go on his plan because he has a PPO and I have a high deductible plan. We are now getting the run around by the idiots in his HR department. We submitted the paperwork because we were told that a change in condition (like marriage) meant immediate coverage. Then, we were told it could not be submitted until open enrollment in November and then I wouldn't be covered until the new insurance year in January. Regardless, I have insurance and I'll be on his insurance prior to the baby coming. However, I'd like to go on now because of the better coverage. My first thought is that my husband should contact his insurance company personally to see if it can be sorted out on that end. And if that doesn't work, he should get his union involved. His union contract essentially says "all employees and their dependents will be covered by the group health plan" or something along those lines. Any advice for a plan of attack or anyone dealt with anything similar?

And please don't tell me I'm not going to be covered because I'm pregnant and that's a pre-existing condition. That's not true.

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Re: Advice on Insurance Issue

  • honestly, that all sounds standard. You were married last year, so you had a thirtyish day window to get enrolled on his plan to be considered a change in condition. The insurance company won't be able to enroll you, as it will have to be through his HR department.
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  • I work in insurance and can tell you the only way you'll be allowed on his coverage in a non open enrollment period is if you have a "Qualifying Event" I.e you lose coverage from your employer, a marriage, a court order, etc. Im sorry but you'd have to wait until the open enrollment. You only have 30 days after your marriage to elect to be on his coverage.

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  • You need a life changing event to become eligible (e.g. marriage, lose of job/insurance, etc.) Also, you have to elect coverage within 30 days of the life event happening. I am 99.99% sure that "becoming pregnant" is NOT a life event. Definitely call your DH's insurance to check. If the new plan year starts 1/1/13 that's at least soon!

    ETA: spelling

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  • I have a PPO now and I miss my high deductible plan.  Are you sure that the PPO is better after you weigh everything?

    HD: For me I paid $160 per paycheck into my health savings account (for 2 people). My employer deposited $1200 per year and paid the premiums.  I paid for each appt after the insurance discounts were applied out of the HSA.  I also paid for prescriptions, glasses, and dental work out of the HSA.  I never paid any money out of pocket and I had a baby. I still have $2000+ in my HSA after leaving there a year ago.

    Now with PPO: I pay $280+ per paycheck for premiums (for 3 people), plus $20-$100+ per appointment for deductibles, plus a 10% copay on services/labs/hospital charges, plus I pay deductibles on prescriptions, and I have to guess on my flex account how much I will end up with out of pocket each year.

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  • Thank you for the explanations on the 30 day window. I wasn't aware of that. No one in his HR department told us that - just keep going back and forth on you can enroll now v. you have to wait until open enrollment.
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  • image rcantor:
    Thank you for the explanations on the 30 day window. I wasn't aware of that. No one in his HR department told us that - just keep going back and forth on you can enroll now v. you have to wait until open enrollment.

    Being in HR myself I am sorry to hear they did not communicate this! It's very fundamental in out field.

    Makes me mad when people assume others should know something so they don't communicate it; like leaving a person a voicemail but no return #.. not helpful! Just because its "common sense" for me does not mean others know too. Like I don't know how to build a car engine but a mechanic does, so it would not helpful for a mechanic to say just screw the top knob to the lower valve.. huh?. Lol sorry for my rant of the day!

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  • The ladies are all correct. My husband works for the goverment and their timeline is 60 days after marriage. I got on my husbands plan once I found out we were pregnant but missed my timeline to cancel my own so I have to pay for it until Jan.

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  • image rcantor:
    Thank you for the explanations on the 30 day window. I wasn't aware of that. No one in his HR department told us that - just keep going back and forth on you can enroll now v. you have to wait until open enrollment.

    30 days applies for the baby too, so while on Maternity leave, make sure to confirm with HR that they enroll him/her and then double check with the insurance company too after they say they've done it!

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  • image SpringPeeper:

    30 days applies for the baby too, so while on Maternity leave, make sure to confirm with HR that they enroll him/her and then double check with the insurance company too after they say they've done it!

    This is SO important. Pack the form in your hospital bag, so that the Dr can just get it submitted for you. 

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  • image Mrs.Leah.Maria:
    image SpringPeeper:

    30 days applies for the baby too, so while on Maternity leave, make sure to confirm with HR that they enroll him/her and then double check with the insurance company too after they say they've done it!

    This is SO important. Pack the form in your hospital bag, so that the Dr can just get it submitted for you. 

    wha? damn, mine wouldn't do it for me! I just had to make a call and say the baby was here and give them the deets, but some HR's work differently. 

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  • I'm surprised they said that pregnancy would be covered if you switched now - or before baby. 

    I was explicitly told that I had to wait 9 months  (After being added to his plan) before I got pregnant in order for them to cover pregnancy on my husbands plan.

    I would call them to double check. 

    NOT your husband's HR - his insurance.

    Usually the employee's company knows nothing about it, but if you contact the insurance company themselves, they have what they call a 'trial-period' or waiting period before certain things are covered.....  

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  • That sounds pretty standard. Just get on his plan in November. It will still cover the delivery. I switched plans during my last pregnancy and had no problems. It might be something to call the insurance company about to make sure, but you should be ok. 
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  • image laurenbell09:
    I'm surprised they said that pregnancy would be covered if you switched now or before baby.nbsp;I was explicitly told that I had to wait 9 months nbsp;After being added to his plan before I got pregnant in order for them to cover pregnancy on my husbands plan.I would call them to double check.nbsp;NOT your husband's HR his insurance. Usually the employee's company knows nothing about it, but if you contact the insurance company themselves, they have what they call a 'trialperiod' or waiting period before certain things are covered..... nbsp;

    Obamacare prevents pregnancy as a preexisting condition.
  • I'm HR girl at work. You have 30 days after a change in status to add onto or drop a plan effective immediately. If you pass the 30 day window you have to wait until open enrollment and start plans the following year.

    Honestly if you don't have to pay I would stay on both plans. Many times secondary ins will help pay copays and deductibles that primary ins does not.

    ETA I should have read all the replies before posting cause I just repeated what the lovely ladies already told you.

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  • you will need to confirm if you are able to get on your hubby's insurance even though you are pregnant. i know obamacare covers preexisting conditions, but i think there are some caveats to that.

    also see if your hubby's hr department needs your baby's info prior to you giving birth. there are some insurances that won't cover newborn care if there is not record of you adding it. my hr rep informed me it's best to do it no later than 30 days before your est. delivery date. 

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  • It sounds pretty normal to me.  Usually, outside of open enrollment periods, you cannot add anyone unless there is written proof that they have lost insurance coverage in the last 30 days or some other event that qualifies like having a baby or getting married.  I know it'd be nice to have the coverage now, but waiting until Dec.1 isn't the end of the world.  Sorry.
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