Spring 1999 ~ Newsletter
Insurance Issues and Cystic Fibrosis
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Questions Commonly Asked About Insurance
by Claire Lenker, MSW, LCSW, CCM
Q. What is the best type of insurance to have?There are as many types of insurance as there are employers - each employer negotiates with carriers (like Blue Cross or United Health Care) to get the benefits they want for their employees. This is why it is very important to read your insurance policy! The co-pays and deductibles can vary greatly. One important feature to look for is called a "lifetime maximum". This amount, usually $500,000 or $1,000,000, is the most an insurance policy will pay for an individual's care for that person's entire life. Large companies are usually able to negotiate better coverage and rates for their employees, so this may be a consideration for adults with CF when they are planning careers or looking for a job.Q. What if I need to stop working or if I lose my job?In this situation, it is important to know about something called COBRA. This federal law allows and employee to continue their health care coverage through their employer, even though they are no longer working. Depending on the circumstances, this coverage can continue between 18 and 36 months. There are many technical aspects of this law that have to do with the reason the employee left work, Medicare, time limits for filing, and becoming eligible for other group plans.Q. We used to hear a lot about pre-existing conditions when we applied for insurance. What's the latest?In the past, individuals with a chronic illness, were often denied coverage or had to wait for their coverage to be effective because they were already diagnosed with a disease or were sick. This was called a pre-existing condition. In 1997, a new federal law called the Health Insurance Portability and Accountability Act or HIPAA, made changes in the way health insurance is regulated. The waiting period before a pre-existing condition can be covered is now limited to 12 months. This means that if an individuals has had health coverage of any kind, including Medicaid, for 12 months, they will have no waiting period for a pre-existing health condition if they change to a new insurance policy. This will make it easier for parents of children with CF or adults with CF to change jobs. HIPAA also makes it illegal for an employer to deny coverage to one employee or their family members due to illness.IF YOU HAVE ANY QUESTIONS TALK TO YOUR CF SOCIAL WORKER.