COBRA Coverage Switching to Kaiser
My ex-employer in California is changing health insurance companies at the first of the year. They are switching to Kaiser and we have been with Blue Shield. The problem for me is that I am on COBRA because of a disability that made me leave me job. I have been on the COBRA for 8 months and still have over 2 years left to stay on it. I am being treated for a back problem and will need surgery in 2 months. I have had my same doctors for 15 years and am afraid that if I have to go to Kaiser I will not get the same treatment that my current doctors are providing me. And I will have to start all over again with the diagnosis and approval. My ex-employer tells me that I can’t stay with Blue Shield because the group is moving to Kaiser and that includes all people on COBRA. Is this true? What can I do to stay with Blue Shield?
It is true that if an employer sponsored group health plan changes insurance carriers, all persons under COBRA also move to that new carrier. To determine if you have options for staying with Blue Shield, you need to contact them and ask about conversion options. This may not be an available option if you have the Kaiser option available to you, but Blue Shield can better advise you on this. You may also want to ask them about an Extension of Benefits option. Extension of Benefits allows you to continue being treated for your current medical condition through your same physicians under the Blue Shield plan. You may need to prove permanent disability and also have this verified by your health plan administrator. With an extension of benefits option, Blue Shield will only provide coverage for the pre-existing medical condition for which treatment has already been started and will not provide benefits for any other health condition or future medical problems. You will need to accept your Kaiser coverage to maintain a comprehensive health plan for all other routine and unexpected treatments. Once your COBRA option has terminated, you will be able to switch back to Blue Shield, or a different carrier, under a guaranteed issue HIPAA plan.
OK, I am not sure I understand all that, but I will call Blue Shield like you advice me. I also completed an online application for Blue Shield yesterday and I am waiting to find out if they approve me for their individual HMO plan.
Comment by James — December 28, 2006 @ 10:01 am
You will most likely be declined for the individual health insurance application you completed online. Blue Shield will review your application like they will any new applicant applying for individual health insurance. In California, an insurance company may decline a person based on the health status. The fact that you are a pending surgical candidate is definitely cause for a decline. You are not eligible for guaranteed issue coverage because you still have a COBRA option available to you through Kaiser. So, don’t put too much hope into getting approved for the individual HMO plan. Your best bet is to ask them about a conversion plan or the extension of benefits option to allow your current physician to complete the treatment of your back problems.
Comment by admin — December 28, 2006 @ 10:06 am
Thank you for your answer to James. These things are not easy to understand and I don’t feel all employers really understand the rules themselves. I wanted to ask you if you could help me with a similar question. I have had coverage with Blue Cross Health Insurance for quite some time now and they have always been easy to deal with. I also need surgery done soon, though not in my back, but in my knee and I can totally understand James concern about changing insurance companies and having to go through that battery of test again. My former employer will also change insurance carrier, not to Kaiser though, but the difference being that since it was a small business I didn’t get COBRA but Cal-Cobra. So naturally I am thinking if the same rules apply has with James, and should I take the same course of action? Thanks
Comment by Daniel — May 31, 2009 @ 10:33 am