Private Health Insurance? — The Bump
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Private Health Insurance?

Ladies, can anyone help me with insight on private health insurance?  I don't even know where to start.  I have coverage through my job, and I don't have to contribute toward the premiums, so that's great.  But my job has become unstable.  We don't want a lapse in coverage, if my company goes under (esp since we're TTC).  So, we're considering adding me to DH's plan (which we can't do til Jan), but it will cost us a lot.  He already has to contribute toward his premium and to add me, it's even more expensive.

So, while I have a little time before his open enrollment, I want to learn the skinny on possible private health insurance.  I remember this being mentioned here a while ago and I'd appreciate any insight you may have. 

Any suggestions for companies to research?  Is there ever IF coverage with some of the companies?  Is pregnancy considered a pre-existing condition (ya know, just in case)?  TIA!!!

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Photo by J Shelton Photography

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Married 10/5/08 | 2 yrs of TTC, tests, procedures & a m/c | IVF #2 =James!

Re: Private Health Insurance?

  • You might look at DH's insurance and ask them if there's a lower premium if they're your secondary insurance.  So then all they'd pick up is stuff that your current insurance doesn't cover.   Also, if you lose your job, that should count as a "change in life" event or something like that so you would be able to add into DH's plan even though it's not open enrollment.  

    Sorry I don't know about private insurance though... good luck.   You know I think there is information on King County's website somewhere - I did look into it many years ago... and I thin kthey had info... you could try there.  Good luck.

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  • I'm not sure about IF coverage, but DH and I recently got private coverage through Regence since I quit my job and he had to go just under f/t hours because of grad class conflict.  It's $113 for each of us (family plan) because we're both under 30 (though I'll turn 30 in May and it will go up $26/month for me...boo) and non-smokers.  I definitely made sure it has maternity and well-baby coverage.  We'd had Regence through work and were pretty happy with the coverage.  The worst part is the $3K deductible for family, but I am hoping that one or both of us will get better coverage by the time we'll be looking at a hospital delivery bill so it may not be too bad of an issue.  This is what we got: http://www.regence.com/WARBS/products/medical/regence-hsa-comprehensive-3000-family-deductible.jsp  Hope that helps! Smile

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  • I have looked into this a little bit since we will be running out of insurance at the end of January (fingers crossed that James gets something else before then).  I found this website:  http://www.ehealthinsurance.com/ehi/Alliance?allid=Goo25151 you don't have to sign up or anything, and it gives kind of a good starting point...at least for me it did.

    Hope that helps.

    T-man (07/27/05, 2:52pm, 10 lbs, 2 oz, 22") My Blog
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    TTC #2 for a million years: SA normal, CD 23 bloodwork shows nothing amiss, ovulation detected. Next step: ? maybe CD3 bloodwork to check eggs? All out of pocket, so limited IF tests/treatments.
  • Also consider the cost of COBRA against being on DH's plan or getting private insurance.  I think different plans have different policies towards what they consider pre-existing conditions and the length of the waiting periods for coverage, if any.

  • IF is not something that is considered "standard" for insurance, I know many companies that don't cover it.  You might be able to get a private policy that does, but it would likely cost you.  Will you try to get another job if your company goes under? 
    BIG Brother born 10/19/07 little Brother born 1/31/12
  • Thanks for the info and suggestions, everyone!  Emma, that site was definitely helpful to get my feet wet.

    I don't expect to get IF coverage (neither of us have it now), but it would have been a nice bonus.  Yes, I'll have to look for a job if my company goes under, or I may look early next year, anyway.  I'm not eager to do that, but an unreliable paycheck isn't great right now, either.

    image
    Photo by J Shelton Photography

    Lilypie First Birthday tickers
    Married 10/5/08 | 2 yrs of TTC, tests, procedures & a m/c | IVF #2 =James!
  • Group Health also has great individual and family plans, and supurb prenatal care (for when you do get your BFP). All of their private plans are listed at their website.

    When I get pregnant again, I am considering purchasing an individual plan from GH.

     

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    Maxwell Joseph 4/09 Lucy Violet 10/12

  • DH is self-employed and I'm SAHM so we have private and have for years... it is PRICEY. We just had to drop down to crappier coverage because it was going to cost us over $800/month for 3 of us...not to mention when new baby comes. We still pay close to $600/month for 3 of us right now but we wanted good coverage and maternity care...you can get cheaper without maternity care and with higher deductibles or office visits not covered but we needed well baby visits all covered and maternity. We have Regnece Breakthru 70 plan...I did a TON of research and comparing and this had what we needed.
  • I was just going to suggest Group Health.

    If I'm not able to get a job right away after graduating we'll probably get one of their plans.  I grew up with them in Tacoma and really liked the medical center on Capitol Hill when I was still on my parents' plan in college.

    Nykola is the one to page about this!

  • DS is on a Regence Breakthru 80 (the highest is now 70) plan for $237/mo and DH is on a Regence plan with a much higher deductible, no maternity or RX,  and a limit on office visits plan for $109/mo. I'm on COBRA becasue of type 1 diabetes.  COBRA is only expensive if your company plan is expensive--it is not anymore than what your company paid for you.  But if your company goes under, you will likely not be able to COBRA as it is a continuation of your company's health plan. No company to have a health plan means no COBRA.

    I recently learned that in WA, private compnaies have to take you on as a client regardless of your health history if you have exhausted COBRA or are not eliglibel for COBRA.  Check out ehealthinsurance.com.

  • Typically you will not find an insurance company in WA state that has Infertility benefits (Microsoft is the only one I know of).

    Pregnancy would be considered a pre-existing condition ONLY if you have received any kind of treatment for it (i.e. had an appointment for being pregnant where they would bill the visit with a diagnosis of pregnancy).  It would NOT be considered a pre-exisitng condition if you have not yet received care for being pregnant yet. Same goes for any condition. 

    I would research deductibles, out of pocket expenses, the network of docs (to make sure you are covered for your certain docs and clinics, and hospitals), your out of pocket maximums, non-covered expenses or exclusions on the policy, and what the maternity benefits are.

    My recommondation would be to try Premera, and Blue Shield.  Both are reputable companies with good histories and are stable. 

    If you have any more quesitons, don't hesitate to ask.  I used to be in the field, so I could probably answer a lot of them for you.  Just page me if you need any help.

    Good luck!

  • My mom works for Nordstroms and has Aetna insurance. When I was going through fertility treatments I remember seeing something in her booklet about IF treatments being covered (maybe iui). Not sure how that works for individual plans though.
  • I work in employee benefits and consult with employers and their employees every day on issues just like this so here's what you need to know.  It's a federal law that pregnancy cannot be considered  a pre-existing condition. If you have to go to an individual plan or your husband's employer plan, your pregnancy will be covered if pregnancy is a covered benefit (it will be on your husband's plan but the individual plan does not have to cover pregnancy). 

    If you were to lose your job, you have 31 days from the date of the loss of coverage to be added to your husband's plan.  This is outside of the annual open enrollment.  It's called HIPAA special enrollment and is a federal law so all group plans have to honor this.  This is HUGE and many people don't realize this or don't remember it.  If you lose coverage involuntarily, you can come on within 31 days.  Keep in mind though, if you take COBRA or get on an individual plan, and decide you don't like it, you CANNOT then get on your husband's plan until the next open enrollment. Since you are TTC, your best bet is your husband's plan.

    Most of the time anymore, it's not worth being covered under both your plan and your husband's plan if you have to pay for the premium of being added.  Because of the HIPAA special enrollment, you can be added once you lose your coverage anyway so it's better to save your money and be added if you lose your coverage.

    Pre-existing condition clauses only come into play if you have a gap of no insurance greater than 62 days.  Any pre-existing condition limitations are credited with your prior coverage.  As long as you have had coverage for 9 months (for most plans in WA state) and no gap greater than 62 days, you will NOT have a pre-existing condition limit (another law).

    Individual plans are a good when you are in a pinch and need something affordable. They are not great coverage.  You cannot buy coverage like your health insurance from your employer on the individual market.  Pay close attention to the limitations and exclusions. Most of the plans have a limited prescription drug benefit, some exclude mental health and pregnancy, none will have IF coverage. Applications for individual coverage are due by the 20th of the preceding month. 

    You will be able to get coverage through private insurance either through the Group Health, Premera, Lifewise or Regence. There are a couple other but most people choose one of these.  If you are declined coverage due to a health condition (5% of people are), you will be placed in the state high risk pool where you will still get coverage but will pay a slightly higher premium to get it. 

    As long as your company doesn't go out of business, you'll also have COBRA.  And, if you lose your coverage due to a layoff by December 31, you get COBRA offered to you, for 9 months at a 65% discount.  It's a great deal!

    Very few employer plans cover IF anymore because it is reallly expensive to add to the plan. In fact, an employer has to be a certain size to even have it as an option from many insurance companies.  A few larger companies choose to add it to their plans but they are few and far between because of the cost.

    I know this is really long but I hope it was helpful.  Feel free to page me if you have any questions. I know insurance is confusing and I don't mind helping! 

  • Wow!!  Thank you all SO much for this great info!  I appreciate it so much.  I was pretty clueless about looking at insurance since I've always had it through my jobs, and always with premiums covered.  It is sounding like the thing to do is keep mine as long as I can since it doesn't cost us anything to have it.  But, in the meantime, I'm going to relate all of this to DH and ask him to find out the exact cost of adding me to his plan (we'd only had an estimate), for when we'll need to do that.

    Thanks, again!!!

    image
    Photo by J Shelton Photography

    Lilypie First Birthday tickers
    Married 10/5/08 | 2 yrs of TTC, tests, procedures & a m/c | IVF #2 =James!
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