health Insurance; Cobra; Obra; Hipaa; Medicare; Definitions, Relationships
Health Insurance; Cobra; Obra; Hipaa; Medicare. If asked, could you state that you knew that all 5 of these topics had the same thing in common: healing guarnatee coverage for you and, perhaps, your family? Would you know the qualifications for each? Well, in this article, we will discuss them. For a timeline that depicts, graphically, the time relationship in the middle of them, please see the timeline in http://www.disabilitykey.com.
health Insurance; Cobra; Obra; Hipaa; Medicare; Definitions, Relationships
Health guarnatee Coverage from Work
If we are lucky, we, and/or our spouse, work for a company that provides, as a benefit, health guarnatee coverage for us and our family. If so, we are very lucky. Even if that is true, there are some key things that you might want to look at to see if you have enough coverage.
1) From your Human Resources department (or wherever else you would go to get information about your health insurance) get what is called a "Summary Plan Description" (Spd). This document should be kept where you can all the time find it, as it contains all the information you will need about what your guarnatee covers and what it doesn't.
2) Look up "Coverage" and "non-coverage" in your Spd.
These will tell you what your plan covers and doesn't cover. You need to see if, perhaps, you or one of the covered members of your family has a health or circumstance that might not be covered, where you need further coverage. For example, let's say that your family has a history of cancer; possibly your plan restricts the estimate of hospitalization days for care; or, restricts the days per condition. In this case, (like my children) you might want to get further "cancer insurance" (I think that Aflac might supply this type of coverage).
It would be a good idea to palpate a health guarnatee benefit Broker and ask him/her to read your Spd and see if you have any gaps in coverage. They then can help you supplement coverage Before You Need It!
No health guarnatee Coverage
You might be one of the growing members of our community that, straight through one circumstance or another, does Not have health guarnatee coverage for your family. In this case, I strongly encourage you to palpate a health guarnatee Broker and get immediate coverage of what is called "catestrophic" (not sure if I spelled this correctly) coverage. In this type of coverage, you will ordinarily have large deductibles, but will have coverage if, say, one of you has to go into the hospital.
Contacting A Benefits guarnatee Broker
Whenever you call or email a health guarnatee Broker, it is very important to get ready ahead of time. What, specifically are you finding for; how much can you afford to pay every month; what circumstances do you want to make sure that your family is covered for. In this way, you can make sure to focus on your considerable needs.
Cobra
Cobra is an acronym ( how can I spell acronym correctly, yet not be sure that I spelled catestrophic correctly?) that stands for: Consolidated Omnibus budget Reconciliation Act. Basically, it is a federal law that allows you to pay for your Company-paid health insurance, as an active member, if you no longer work for that company for, ordinarily 18 further months.
1) Cobra is "triggered" (that is, you, or a covered member of your family, become eligible for Cobra) by events such as the following: resignation from the company; termination (For Any Reason) from the company; separation of a spouse; a covered chile's birthday makes them ineligible for coverage. These are the main "triggering" events for Cobra.
2) Now, when eligible for Cobra, you will be asked to pay for 100% to 105% of the company's employee/employee and family coverage amount. You should get a letter from your company explaining what that estimate will be. Before You decree To Take Cobra, there are some important things for you to consider.
What will be your cost, and what will be the coverage for that cost?
Sometimes the cost is too much for the coverage. In these cases, you might want to make your mind up Hipaa coverage, instead (see Hipaa below).
Or, you might just want to get catestrophic coverage as was mentioned earlier, and wait for full coverage under your next job.
Part of this decision should be whether or not you or a member of your family has what is called a "pre-exisitng coverage" condition.
Here again, before automatically taking Cobra, it would be wise to palpate a Benefits guarnatee Broker and give him/her all of your options, and get their input. I have worked extensively with a Benefits guarnatee Broker, and he is de facto fantastic!
Obra
What, you ask, is Obra? I've never heard of it, you say, and no one I know has heard of it either! Well, that's because, 99% of Human reserved supply or benefit folks that I know have never heard of it! Obra is a federal law that was passed that extends Cobra for an further 11 months For Disability Purposes Only!! Why, you ask, is this important? Thanks for asking, let's see if I can explain.
If you are as nieve (did I spell this wrong too? sorry!) as I was when I first started finding to bridge my health guarnatee from working to Medicare, I assumed that when I got straight through all of the hoops to qualify for Ssdi (Social safety Disabililty Insurance) I'd Immediately be eligible for Medicare, Right??? Wrong!!!!
When you ultimately qualify for Ssdi, you have to wait for 5 months before you get your first check. And, the rules state that, you are eligible for Medicare 2 years (24 months) From The Date Of Your First Ssdi Payment. Well, if you add 24 + 5 you get, 29 months in the middle of qualifying for Ssdi, and Medicare coverage.
Ok, I said earlier that Cobra is for 18 months of coverage. Well guess what 18 months of Cobra + 11 months of Obra equal - 29 months!
But, there are two catches to Obra; first of all, you have a small window of 30 - 60 days to apply ( this window opens the date of your Ssdi approval); and, it can cost up to 150% of your plan coverage amount. But, if you have a "previously existing condition" this might be the best way for you to proceed.
Again, it is important to palpate a health guarnatee Broker to help you with the risk/cost ratio of all of these situations.
It is also improtant to know all of these deadlines as you plan to ensure that you and your family have important health guarnatee coverage.
Hipaa
Hipaa is a federal law that is called, briefly, the "portability" law for health insurance. What that means is that when you leave a group (read company-paid plan), the carrier that in case,granted that plan, must offer to you, another plan, dissimilar from Cobra, when you leave the group coverage. ordinarily this will be what is called a "bare bones" plan. Again, the best thing for you to do is to call/email a health Insurance/Benefits Broker with all of your information: Spd, Cobra info, Hipaa info, needs, cost limits, and let him/her help you find the optimum plan coverage for you.
Medicare
Ok, now, finally, we've reached Medicare! But (you de facto didn't think it would be that easy, did you?) if you have remarkable for Medicare because of disability, there are Restrictions (of procedure there are!).
First of all, if you are qualifying for Medicare because of disability, you are probably under the age of 65 - normal resignation age.
Medicare coverage does Not cover prescribe drugs, which, those of us with disabilities probably need, and which cost lots.
But, Congress prescribed that states (all but 11) offer what is called "Medicare supplement" plans, some of which do offer prescribe coverages.
But, these plans Are Not Required To, and do not, offer these medicare supplement plans that offer prescribe coverages to folks who qualify under age 65! So, if you are qualifying because of disability, your healing guarnatee plan doesn't cover one of your primary cost expenditures!
Here again is where you need to palpate a health insurance/benefit broker. Again, he/she can work with you, and your specific circumstances, to get you the coverage you need.
Hope that this information was helpful to you. If you have any questions, please feel to ask them by commenting on this blog, and I'll be happy to get you an answer.
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