Pre-ex with Group when There is IFP Currently?
I'm working with a small company to get them a group health plan (With CalChoice). I need to have 70% participation so it is vital we get the vast majority of the the employees. I got the following last night. I sent it to my GA for an answer but I thought one of you might know. (I've written a lot of small groups, but this has never come up before.)
Quote:
3) One of our employees currently has an individual health plan that she is signed up for and has been on for a while. When she signed up, they denied her coverage for "preexisting" conditions for six month, which she just recently cleared. She is concerned that if she converts over and signs up for our group health plan, she will have to go through a whole new, extended "waiting period" for any "preexisting" conditions.
QUESTION: If an employee who currently has individual
Coverage, and has cleared the waiting period under her existing plan for a preexisting condition, signs up for the proposed compoany plan, will she be penalized (as compared to sticking with her current, individual plan) by having to go through a new waiting period before any "preexisting" condition will be included in her coverage?
I'm going to guess that the woman will have to wait six months on pre-ex... which might torpedo the group unless there is a way to get get her to join with double coverage. But why would she want to pay 2 premiums (company is only paying 55% of a low-cost option.) We really need her to make participation ratio. Maybe company could "bonus" her the premium for 6 months... but if it gets out the other are going to be pissed.
According to the CalChoice UW guidelines:
Pre-existing conditions are excluded unless continuously
Insured for six consecutive months. A pre-existing
Condition is an injury or sickness for which the covered...
