Sunday, June 05, 2005

Divorce; lost Health Insurance Question about self and children

Recently, I had a question from someone who was going through a divorce and was concerned about lost health insurance coverage because she was covered under her husband's insurance. She was concerned not just for herself, but for her children as well. This question comes up a lot. See is this answer helps you better understand what to do. If you have additional questions on this topic, feel free to add to the blog, and I'll answer them.

Medical Insurance and Divorce
To answer your questions specifically, here are some ideas to consider.

1) You and your children are automatically covered under your husband's insurance as a dependent until you divorce.

2) When your divorce is final, you have the opportunity to continue your husband's insurance by triggering what is called "COBRA". (Note: there is another blog entry that defined COBRA.) This will continue your coverage for an additional 18 months; unfortunately, you will have to pay the full cost of the coverage (and the company can have you pay 102 - 105% of the coverage cost).

Your children, by law, will becovered under the parent's coverage whose birth date occurs first in the calender year.

3) One suggestion is that when you hire an Attorney to assist with your divorce, you might want to ask, in the settlement negotiations, to have the price of the COBRA payments included in your settlement. This would be particularly important if you happen to have the early-in-the year birthdate, and will be paying for the children's health insurance coverage. This cost should not have to come out of your child support, as it can be VERY EXPENSIVE.

4) Whatever you decided to do, keep all documents together. Whenever you talk to anyone, document to whom you talk, get the name and tele #, and what was said by all in the conversation as soon as possible after the conversation. In this way, you document what is said, and do not have to rely on memory. Also, when you send anything to anyone, keep a copy for yourself, and send it by registered mail, so that you have proof of receipt. Please feel free to contact me again with additional questions as you continue your journey.

Disability Insurance and Medical Insurance Definitions

Tonight is Sunday evening. I hope that you all had a fantastic Sunday. I have a 21 month old granddaughter who is the light of my life. This week-end she counted up to 10! However, I think that she believes that "six-seven" is one number. What fun.

Disability and Medical Insurance definitions. You have plans, and you have read about such things as: COBRA, OBRA, Own Occupation, Any Occupation, etc., and you REALLY want a simple definition. Well, we have them for you.

To see a Timeline that makes graphic sense about all of these definitions, please see www.disabilitykey.com. To ask a question, add onto one of these blogs.

DEFINITIONS

1. ACTIVE: Active medical insurance coverage means that you and/or your family are covered by a medical insurance plan. Usually, these plans are “group” plans carried by your, or your spouse’s employer (in which case, you are the “covered dependent”).

2. COBRA: COBRA is an acronym for “Consolidated Omnibus Budget Reconciliation Act”. It refers to an active medical coverage person’s ability to continue coverage as an inactive participant for 18 and, sometimes 36 months, when a “triggering event” occurs. Loss of active coverage status is a triggering event. A triggering event includes, but is not limited, to the following: loss of active coverage because the primary covered person lost his/her job (for any reason); divorce; a covered child's age exceeds that covered in the Plan. The cost of COBRA coverage is at least 100% of the Employer's cost, and can be 102% or 105%.

3. OBRA: OBRA rules allow a “qualified” disabled person to extend COBRA for an additional 11 months based on disability. There are key conditions; 1) the person must be SSDI qualified; 2) the person must request OBRA within the first 60 (sometimes 30) days of having received the SSDI determination letter; and, 3) the Plan Administrator may charge 150% of the COBRA price for coverage.

4. Medicare: When a person becomes SSDI-qualified, s/he is eligible for Medicare 24 months from the date of the first month of SSDI payment. As there is a 5-month waiting time from SSDI-qualification until the first month of payment (and this occurs the second Wednesday of the months AFTER the 5th month), the actual waiting time is 29 months.

5. HIPAA: HIPAA is an acronym for Health Insurance Portability and Accountability Act of 1996. It is a way for people who either do not choose COBRA, or who need to trigger additional health insurance before Medicare, to obtain some coverage.

6. 30-180 day Elimination Period for LTD: In most cases, a company’s LTD (long term disability) plan has an elimination period of time equal to the length of the company’s STD (short term disability) coverage. During this time, the employee is expected to obtain income any way s/he can.

7. Own Occupation: To be found “disabled from your own occupation” means that you have been determined to be unable to perform the “work” that you had successfully performed prior to evidence that your illness/injury symptoms impaired your satisfactory performance of the essential duties of your job. The key here, is that the evidence must prove that your inability to successfully perform your “own occupation” must ONLY be attributed to impairment caused by the symptoms from your proven, documented, disabling illness/injury.

8. Any Occupation: To be found “disabled from any occupation” means that, in spite of your age, level of education, and previous job history, the symptoms of your proven, documented disabling illness/injury impair you from performing work of any occupation. The reason, for LTD insurance purposes, that this impairment from performing work of any occupation is periodically reviewed, is that there are times when a person’s physical capabilities can improve. Disability pay only continues as long as there is proven evidence that the symptoms impair “work”. Often the "periodic review" occurs annually.

If you have any additional questions about any of these definitions, please ask them.