Cancer as a pre-existing condition for insurance
Hello fellow cancer survivors! Thought I would see if anyone else has been in the boat I am in.
I am currently employed and my insurance was overall really great with coverage while I went through surgery and RADS for DCIS last fall. However, I may be out of a job soon and am wondering when I get another one, will I be excluded or have to pay a higher amount due to having had cancer? Meaning do I have to show it as a pre-exisiting condition and if so can I be denied coverage or charged out the rear for it?
If I am unemployed for a time and stay on COBRA will that help any as far as the cancer being seen as a pre-exisiting condition when I get a new job with new insurance? I just finished treatment in Oct but of course am still seeing my oncologist and having mammograms pretty often for the first year.
Thanks!
Comments
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Make sure you get a letter of insurability from your current insurer. It will just say you had insurance with no lapse in coverage and are insurable. If your new job is a group policy I don't think they can discriminate against you for preexisting conditions. I thought Obamacare eliminated that???
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I thought that if you had continuing coverage, and went into a group (as opposed to buying your own individual insurance) that they couldn't exclude pre-existing conditions. But I am not totally sure on this.Hopefully someone will chime in here with more definitive info
BUT I do know that what you want is a 'certificate of continuing coverage' (CCC) from your prev insuranance company. I know that you do not want to have more than a 62 day period of being 'uncovered', as that allows the new company to not cover everything. If you have continuing coverage (as proven by the CCC), they have to cover you completely. At least, that is my understanding, and that goes for GROUP coverage. I think for individual coverage, the company can pretty much exclude anything they want.
My daughter got an individual policy last year and they excluded anything reproductive for A YEAR because she had a little spot on her cervix that they were watching. It cleared up on its own and the year is over now, but I definitely held my breath til the 12 months were done.
Good luck. I KNOW how stressful insurance/financial stuff can be. If you get stuck, maybe the state insurance commissioner's office would be able to give you some information.
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Thanks so much to you both for your posts. And the Obama care thing I believe is only currently in effect for minors, not adults, though hopefully adults will be added next year. If I do become unemployed I will for sure stay on COBRA eventhough it is expensive it is still cheaper than medical bills!
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texaslonghorn. As folks have mentioned as long as your insurance is continuous (no break for more than about a month) then you can go on another group plan. As far as individual plan I do believe you will be denied.
I was on cobra but it was about to run out before my last chemo. I called BC&BS of Illinois and they said cancer is a non-insurable condition. BUT I am on my state's high risk pool insurance instead. The premiums charge is by age not condition.
This is a list of states with high risk pool insurance: linky
Texas link ((888) 398-3927) is here: linky
NOTE: it does say 12 month waiting period but I do believe that is only for people who don't have continuous coverage. If you apply now for when your cobra runs out you will not have to wait the 12 months. In Illinois it was 6 month waiting period but I did not have to wait because there was no lapse in my health insurance.
hope that makes sense.
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Lago..... THANK YOU so very much for that information! I will most certainly keep that handy! I still have great coverage through my job... but again, the job may be going away soon and while I know I will get another one at some point, I will need to maintain the COBRA.
Thanks again all!
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Not sure how it works but I did ask my insurer (CIGNA) if my BC would be a pre existing condition if I needed to apply for different insurance in the future.
They told me as long as I was 'treatment free' for 12 months it is not considered a pre existing condition.
As far as Obama care it only covers those under 17 or 18 years of age now. Not sure if adults are included in the future.
Jan
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jan Obama care kicks in for adults in 2013 unless it's repealed. Also be careful regarding "treatment free" If you are on a hormone sucking or hormone blocking (Als or tamoxifen) then you are still being treated for BC.
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Thanks lago.... so far I am on nothing... I refused Tamoxifin at this time as I was only at a 7% chance of getting cancer in the first place, and with it they told me it would only reduce the risk of getting it in the otehr breast by half... and being just newly 40 and not having gone through menopause, I didn't want to take it at this time for only a 3.5% chance of getting a recurrance.
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texas you might also be in a better situation with insurance classification being stage 0 DCIS.
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Lago - I sure hope so!
Does anyone know how long you have to be considered NED before cancer is NOT considered a pre-exisiting condition?
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Texas - I was dx'd two months after being laid off - luckily I did opt for COBRA and my COBRA ran out just in time for open enrollment with my new employer (Group - no pre existing issues but my deductible is sky high). As long as you have continuous coverage, no lapse of 60 days or more and your 'new' employer offers health care you should be fine...
Lago thanks for the link to the high risk pool information!
I had inquired about Term life and I have to be NED and out of treatment for 5 yrs before I can get life insurance...I do wonder how that will work with my Thyroid Cancer dx and now having to take a Thyroid supplement for the rest of my life
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Thanks O2bhealthy. That is great to know. While the COBRA is expensive it will be worth it to keep the insurance and not have that lapse. Thanks again all for the info! You all are the best!
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I have heard 5 years NED to be considered in remission as well.
Yes the Obama care laws that went into effect this fall include no pre-existing condition for employers as long as you have had continuous coverage.
Really the main issues is if you have had a lapse in coverage and/or your coverage is about to run out and you can't get on another group plan. Insurance will deny you coverage for an individual plan if you have had a diagnosis of cancer… but I don't know if there is an actual time limit on that.
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Hi,
In Ontario Canada we luckily do not have to worry about most health care costs relating to cancer however some treatments are not covered under the provincial health care plan, like neulasta at $3000 per shot - luckily for me my DH medical insurance plan artwork covered it at the time although since then his employer has lowered every ones coverage and they would now not cover any of the cost. On another issue I am about to purchase a new vehicle on finance of course, I cannot get disability coverage or life insurance as my bc is considered a pre-existing condition, actually they will cover me but cancer will be an exclusion, and that's the thing I worry most about coming back, go figure. Yes, they do say if you have had no treatment for 12 months, but they consider AIs to be treatment plus you cannot have seen a GP or onc for 12 months which I am sure we all fall outside that category as we have scheduled return visits for the remainder of our lives at least 6 monthly or annually, so if they don't catch us with the treatment clause they sure as hell catch us with the onc visits even though these are routine check ups. This makes me so cross - how are we supposed to try and put this thing behind us when the insurance companies will not. We may not ever have a recurrence again (let's hope!) ....and yet we will have these exclusions as a constant reminder, on top of the scars that is!!! I know the insurance companies are out to make money but .... sorry for the rant this just really p#sses me off. The last thing I want to do is purchase a vehicle and then something happen and leave my DH footing the bill, you know what I mean right?
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Does anyone know if a biopsy (benign) is consdered as treatment? My husband will retire in 2 years (we will both be 62), we are hoping to have some kind of insurance until medicare kicks in but I am getting skeptical now, i have not had any real treatments since finishing rads 7 years ago, refused tamox and AIs but keep having issues with bad mammos, leading to biopsies and now yearly MRI on affected breast. How about future colonoscopies since I have had colon cancer also, this insurance stuff is so confusing...and arthritus treatment, oh nooo
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Susan you would really have to check with an insurance company. The thing is in 2 years Obama care will kick in and there will be no pre-existing condition issue anymore for anyone here. Of course we all worry about it being repealed.
My gut says that if you are 5 years NED with colon cancer then you are in remission… colonoscopies are not treatment. Even someone who had a polyp removed gets more frequent colonoscopies as well as those with a direct family history.
BTW congratulations on NED 7 years breast cancer and how every long colon cancer. That's something to celebrate.
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lago, thanks for the reply, I am just going to roll with it then, not sweat the small stuff !
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I had Cobra till july of 2010, pickedit up on my own (it was very expensive), was on that for 3 mos., then Qualified for Heathy New York by virtue of my income level. I have had no lapse in coverage, and Univera has been great about covering all BC related appt's. scans, blood work etc. It is a worry when you are trying to fight the ins. maze along with fighting the cancer. If you type in COBRA in the search engine on the pink navigation area, you will find a wealth of good info about pre-existing conditions, also type in my avatar name and it should pop up for you. Good luck to you and I hope this dual worrying will go to just (ha) fighting the cancer.
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I knew someone here would have some answers to questions I just had to start asking due to my husband's company going out of business and how COBRA could be affected by it.
Just in case anyone wants to know if the previous employer does not keep an active group policy in effect COBRA will discontinue coverage leaving us ladies out there high and dry.
Individual policies have higher deductibles and can and will deny us for a pre-existing condition. There is a time limit that varies company to company. Sadly your existing company can and will deny you for a pre-existing condition - even though they are the one that initially insured you.
Many of them have a time frame that they operate with some it is 10, it just varies.Some offer an alternative but it is more expensive it is a Guaranteed Insurance Policy basically they do not ask you medical questions but it does cost more and Individual plans have higher deductibles than Group plans for some reason. But hey it is insurance and after being told I would be rejected if I went through medical underwriting well I will take what I can get since I do not have the option of a group plan.
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The no-lapse in policy used to be 63 days: 2-31 day months plus one day. I know Oklahoma now has a high rish pool, the premiums are as high as what it cost me to have hubby on my insurance, almost double for what cost for me alone. Personnally, I wouldn't want to count on Obama care. He already wants to reduce spending by cutting medicare & medicaid as announced today in the news. Not wanting to start anything, but expressing my opinion. NJ
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Hi Texaslonghorn --
One thing we all need to remember is that insurance is different in different states. Some states may have laws requiring that insurers accept everyone, others will allow insurers to deny coverage. So while "Obamacare" affects all of us, individual state laws apply as well. (Texas tends to be a rather libertarian state, so I doubt there are lots of insurance consumer protections there, but in some states those protections do exist.)
Texaslonghorn asked: "I may be out of a job soon and am wondering when I get another one, will I be excluded or have to pay a higher amount due to having had cancer? Meaning do I have to show it as a pre-exisiting condition and if so can I be denied coverage or charged out the rear for it?"
I believe the federal law that applies here is HIPPA rather than "Obamacare." HIPPA, the Health Insurance Privacy and Portability Act, was created during the Clinton administration. The "Portability" part is what Texaslonghorn is talking about. Because of HIPPA, if you lose your job but have been covered by insurance for some number of months (I think it's 18 or 24), you are entitled to COBRA coverage while you look for another insurance plan.
Also under HIPPA, if you've had the minimum amount of "continuous coverage," you cannot be denied coverage by another insurer. You may be put in a higher cost HIPPA plan, but you can't be refused coverage.
So to answer your question about being refused, no, you can't be refused for any reason as long as you meet the deadlines that allow you to qualify continuing coverage. However, when you apply for new health insurance you will have to fill out a questionnaire that will ask about things like cancer. In my experience, health insurers are extremely picky about these things and you will probably be forced to purchase a higher-cost HIPPA plan. (My experience is that if you've ever had a cold or a nosebleed you'll be put in HIPPA.)
"If I am unemployed for a time and stay on COBRA will that help any as far as the cancer being seen as a pre-exisiting condition when I get a new job with new insurance? I just finished treatment in Oct but of course am still seeing my oncologist and having mammograms pretty often for the first year."
Only the insurance companies can answer this for sure, but in my experience you will be considered to be a cancer patient and will be put in the higher-cost HIPPA category. Possibly if you were more than 5 years post-treatment you'd be "in the clear" but it's doubtful even then. They will find some reason to deny you regular coverage. That's just what they do.
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I have Stage IV BC and currently have COBRA for a total of 36 months (federal Cobra first and then state COBRA) because my employer was based in California and they had to offer me an additional 18 months.
I live in New York and will have a six month lapse in coverage before my Medicare through SSDI is effective. Specifically, my COBRA will end in May 2012 and my Medicare will be effecitve on November 1, 2012. Where would I be able to get individual coverage in New York for the 6 month period before Medicare starts since I know I can't extend my Cobra any longer. I am willing to pay what I have to, however, I don't who to turn to and I'm not eligible for Medicaid or Healthy New York, although my income is low,, however I do have assets.
I hope someone knows how I can get 6 months of coverage prior to Medicare whereby I don't have to worry about pre-existing conditions, etc., PLEASE HELP.
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Lago - Any restrictions to get into the IL high risk pool?
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The only restriction is that there is no other insurance option for you. In other words if your employer offers health insurance you will not be eligible or if you can get a policy on your own ( breast cancer diagnosis is usually non insurable under non group policies) then your are not eligible.
I'm on it. Give me a call if you want more detail. I recommend signing up 3 months before your insurance is going to run out. The people at ICHIPS are really very helpful. I recommend calling. The coverage is BC&BS of IL PPO. I didn't have to wait 6 months… When cobra ended I started this.
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Gaynorl have you tried Manulife Financial, RBC Insurance or Canada Protection Plan. There are brokers that will find you an insurance policy also. Usually where you buy your car insurance. Manulife has a guaranteed acceptance life insurance policy - no medical questions.
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The time liimits talked about are related to HIPAA. The Health Insurance Portability and Accountability Act of 1996. As was stated by Norma June, you can't have a lapse in coverage of more than 63 days. Also if you maintain coverage with a previous employer for a period of12 months, then you exclusion time limit is covered. COBRA counts as coverage, so
If you you have coverage for cancer with your current employer for 2 years, then your job ends and you carry COBRA coverage for 4 months, then start a new job with an employer that offers group health care and that group policy covers cancer treatment but has a preexisting condition clause, it would most likely not apply to you and you would be covered under the new employers plan. ( I say most likely becasue I am not a lawyer....but the way it is written,you should be eligable for coverage.) I dug deep into this a couple months ago because I anticipate there will be a time when my wife will have to stop working ( not soon) and I will want to cover her on my group health policy.
You can see this informaiton on the Department of Labor's website.
http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html -
PizzaDad you are correct although I'm not a lawyer either. Not having the lapse is crusial. I'm not sure if part of this was the HIPAA and/or also part of Obamacare that was passed this past October.
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Ritaew - you should be able to get HIPPA-guaranteed coverage from any insurance company. They WILL ask about pre-existing conditions, and the cost of the policy may be rather high, but they can't deny you. That's what the "Portability" in HIPPA means -- basically, that if you had coverage before you can't be denied new coverage.
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Ran up on this when I was seeking lung cancer assistance. It is from a website called Cancer.org and it explains
Understanding the 2010 Health Reform Law
There are also other websites listed for financial help and an online booklet Managing the Cost of Cancer Care.
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