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Going from individual to group insurance
Nov 21, 2002

It seems I am able to qualify for group insurance through a company I own at a cost of about 20,000/year. I presently have individual coverage but the lifetime cap is low relative to the cost of my treatment.

Q1. Will there be a waiting period for pre-existing condition (immune disorder) when I buy the group coverage, or does HIPAA prevent this given that I have an individual policy?

Q2. The individual policy has a permanent pre-existing condition exclusion rider for an unrelated condition(back problem/spinal fusion). Will this affect anything?

Q3. What happens if the lifetime cap of the individual policy has been exceeded or is close to being exceeded when we apply for group coverage? Will this affect the rights under HIPAA?

Q4. If I obtain the group coverage now, can I continue to keep the individual plan in effect until the lifetime cap is maxed out?

Q5. How long, conservatively, can it take to obtain a group plan for a small business? If I anticipate the lifetime cap for the individual plan being maxed out in 18 months how soon should I start the formal application process for the group plan?

Response from Ms. Franzoi

Q1. HIPAA would apply. Your period of coverage under your health plan would apply to any pre-existing condition exclusion period in the group plan.

Q2. No. Please see the answer to Q1. If the group plan has a pre-exisitng exclusion period, your period of coverage under your prior plan would count towards this period.

Q3. This should not matter. What would matter is if you went 63 days without coverage. If this happened, HIPAA would not apply.

Q4. You should be able to carry both coverages. However, both the individual and group policies will have coordination of benefit language. You should review this carefully in both to see how it will work and to determine whether or not, you should continue both coverage.

Q5. I suggest contacting an insurance broker to determine how long it will take to get a small group plan in place and what your options are with respect to the plans available in your area.



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