Sjogrens and Insurance coverage

[SueAnn]

Hello All,

I was just wondering if after you have been diagnosed you have moved or changed jobs and had problems getting health insurance coverage.   We are thinking of moving out of state and I am concerned about leaving my job.  I may not have any choice in the matter if budget cuts are as bad in the schools as they say they are going to be next year (I have already been told I might be cut for next year).

I guess what I am wondering is, as the SJS progresses and health issues start getting bigger will they say "oh, that's related and not covered". 

Any input would be helpful.

SueAnn

[Scottietottie]

Hi SueAnn 

I'm soeey - I'm not of any help because I'm in the UK. I know SjS etc had implications for getting travel insurance. Thankfully I don't have to worry about medical insurance over here.

Take care - Scottie 

[JannaLee]

SueAnn,

I am worried about this also.  If I start a new job with new insurance is the Sjogren's considered "pre-existing" and so they don't have to cover it? 

I hadn't even thought of how they could relate EVERYTHING ELSE to Sjogren's and refuse that care too!!!

Hopefully someone will know the answer to this.

Janna

[Pooh]

SueAnn,
I think you will find that each insurance company will have a different criteria for this.  When we were changing coverage, we were told by one company that my husband wouldn't be covered because he had Lupus.  It was a pre-exsisting diagnoses.  However,  the company we went with in the end, had no such clause, only a 90 day waiting period.  (Highmark Blue Shield)

So, you would do well if you checked into the company you are interested in going to for coverage. 

Pooh

[Linda196]

I've changed plans, but not carriers, 3 times in the last 5 years, because going from full time employment to disability, then to retirement, then to my husbands plan each required a change (don't know why, coverage stayed the same), but luckily as long as there was no lapse in coverage, the provider continued my coverage. I got that in writing before each change, by the way.

The document I received as a guarantee actually said "if full medical insurance coverage has been in place, with no lapse at the time of issue of the new policy, the newly issued policy will not identify (SjS, hypertension, sarcoidosis, GERD, or migraine) as non-covered pre-existing conditions", and it appeared to be (except for the list of conditions) a form letter. Given the wording, I think it would have to include coverage from another provider, because it doesn't specify Medavie Blue Cross. Please bear in mind that health care and insurance is much different in Canada, as it doesn't have to cover the basics, just "extras" like RX medications or treatments not given in hospital or extra-mural, glasses and dental work.

[Jennypa]

Isn't it ridiculous that we even have to worry about that!!!!  How ridiculous!  If you are sick, you are sick, period and if you're working and paying for insurance, it shouldn't matter when the diagnosis came!  I had that worry too when my husband switched jobs but I understand it is more of a problem if you are going after an individual policy and not so much so when it is a group plan.  Not to get political or anything but I hope someone gets into office and starts working on our healthcare.......

[Seeker]

SueAnn, you have hit on a very perplexing problem.  If the insurance company considers Sjogren's as a preexisting condition, it could get very confusing on what's covered and whats not.  It also depends on your age group.  In the US you have a wonderful group called AARP that can help you find a policy.  AARP helps people who are 50 years old or older. 

You need to do your home work when choosing health insurance.  I am sure there is a provider out there that will meet your needs.  One thing you can do while doing your research is have a list of questions to ask a provider.  Also if there is anything that they say which is unclear, do not be afraid to ask for clarification. 

Check the internet.  I have seen a few web sites that have provider comparison charts.  This will help you narrow the field down.  Also ask your fellow employees at your new job.  They will have some good incites. 

I hope your job hunting will meet with great success.

Seeker

[Victoria05202000]

SueAnn,

I would check out the insurance prior like most suggested.  I know "MOST" insurances state no pre-exsisting conditions, BUT the key is as long as there is NO LAPSE of coverage.  This means you go from one insurance and straight into the next without a time with no insurance.  I am starting an insurance with my work on Oct. 1, 2008....and even though I am going to "hopefully" going to a kidney transplant within the next 6-8 months...they are taking me because there is "No Lapse" in coverage.  I am currently on my hubs insurance and I am keeping it as my secondary.    Hope this helps!

Take Care!
Vicky

www.sjogrensandme.blogspot.com

[SeaBreeze]

Hi..
If you are in the USA and if its a group insurance from your employer; there was afederal bill passed called the Portable Insurance Act  (1996) I believe it states whatever conditions you have already covered should be covered by the new insurance.. It's worth checking out.  Good luck...

[Calli66]

Here in New Mexico, if you have group insurance with your employer, the insurance company cannot reject you for pre-existing conditions. It's only if you go with "individual" insurance, they screen out pre-existing conditions. I'm really thankful that we have our own company. My husband and I are over 50, but our son (the other partner of the company) is in his 20's, and that seems to keep our rates down. In New Mexico you can have group insurance with as few as 2 company employees, but you have to submit copies of state payroll reports to show you have a legitimate company.

I went to an insurance broker. They don't charge any extra, and they were really helpful getting multiple quotes from different carriers, and explaining the policies.

C

[salsen]

Linda is right.  There is a federal law that says if you maintain coverage and do not lapse coverage between jobs that you will be picked up.  You may have a waiting period when you join a new company but as long as you maintain coverage for six months prior to hire they have to pick you up.  That is what cobra insurance is all about.  It a bridge to help you retain coverage between jobs.  The big problem for most people is the cost of maintaining the insurance through Cobra.  It is much more expensive.

My husband and I had to go this route when he changed jobs and it cost us close to $700 a month to keep up the coverage for close to eight months until he found a job and the new insurance became effective.  Expensive --YES!  Was it worth it -- YES!  We both have major auto immune problems and we were added to the new insurance company with no problem.  Our previous company sent records to show we had no lapse in coverage.  Good luck.