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Going back to work; can I qualify for health ins?
Apr 9, 1997

I recently accepted a new position after being off work for nearly a year to recuperate from a PCP bout. I was also diagnosed with CMV retinitis, which hasa been inactive for several months. During that time, I was unable to keep my previous employer's health insurance past the COBRA period because of the high cost, and went on Medicaid and Social Security Disability. My question: is it possible to qualify for my new employer's plan, or must I look to insure myself during a company's open enrollment period?

Response from Ms. Franzoi

You need to look at the terms of your new employer's plan. Does it have a waiting period? Is there a pre-existing condition clause?

Most group plans offered by an employer have eligibility and preexisting condition clauses. You need to look at the terms of the plan in order to determine what you need to do. The sections you need to review under the summary plan description for the employer's medical plan are:

Eligibility: What class of employees or groups of employees are eligible to participate? Does the plan require you to be a full time employee wotking a specified number of hours? If so, do you satisfy that requirement? Does the plan have a waiting period before you qualify? If so, how long must you work before you are covered? Pre-existing Condition Clause: Is there a pre-ex exclusion in the plan? If so, what are the terms of it and how does it apply to you?

Most employer's plans, if you are in the eligible class of employees and have satisfied the waiting period, will let you into the plan without evidence of insurability if you enroll within 30 days of first becoming eligible. Once again, read the enrolllment and new hire literature carefully to see what the terms are and how they apply to you.

- Lynn Franzoi



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