Apr 24, 2008
i am currently receiving ny medicaid. i am starting a job that is offering oxford freedom plan health insurance. 1. will my condition be considered "pre-existing" and will i have a waiting period for benefits and what kind of prescription coverage can i expect, such as limit to how much insurance will pay fro medications?
Response from Ms. Franzoi
When you start your new job and are offered coverage, if you sign up during the intial enrollment period (usually 30 days from date of eligiblity), even if the plan has a pre-existing condition clause in it, the plan will have to recognize your peiod of coverage under Medicaid towards that exclusion period. This is called Creditable Coverage. The exclusion period cannot be greater than 12 months. So if you had Medicaid for at least 12 consecutive months, there would be no pre-existing exclusion applied to you. This assumes that you do not have a break in coverage of 63 days or more. The type of prescription coverage you will have depends on the plan design. Some plans offer a 3-tier approach (for example, the plan might have a 10% co-pay for generics, 20% for formulary brand and 40% for non-formulary brand). There could be a deductible and possibly a maximum annual out-of-pocket that you will have to pay. You could ask the prospective employer for a summary plan sdescription of the health plan which would explain this.
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