Individual Policy

[starburst01]

Ileft my former employment to start my own firm last year.  It is very rewarding, but I am having a great deal of trouble getting insurance.  I wanted to get an individual policy, high deductible, with the physicians we use in the network.  The problem is that I have a benign arrthymia known as PACs (premature atrial contractions).  I have been assured by my internist and cariologist that there is no problem, and no treatment is required.  Moreover, we went down this road because I am an amateur athlete, and my internist wanted to make sure that the arrthymia would not cause a problem in the course of my long distance running.  I was cleared to do anything I want.

This makes no difference to the insurers, however.  They seem to be looking for an excuse to deny coverage, and in fact they have.  I may be stuck with a group I can join, but which has a very high premium due to the high average age of the group (most, like me, are in their 50s), or perhaps a COBRA (or is it HIPAA) individual conversion policy without medical underwriting, which I understand is available to me, but at what will probably be a staggering cost.

I have two questions.  First, it is stressful enough to have this arrthymia even though the physicians assure me there is nothing to wory about.  The insurers seemingly indicating that there is, and frankly I hate that.  Is this typical in circumstances like mine?

Second, are there other options for more affordable coverage?  (I live in Maryland).

[Amir Mostafaie]

Dear starburst01,

It is typical for health Insurance Companies to deny coverage to an applicant with most types of Arrthymias even though cardiologists don't see that as alarming. Under your circumstances for all practical purposes, you should listen to your physician instead of health Insurance underwriters. Depending on if you elected COBRA after leaving your former employer, you may have the following options:

If you elected COBRA after leaving your employment, you can continue with the COBRA coverage as long you pay your premiums, for 18 months from when you left your employment. After you exhaust the 18 months of COBRA, you will be eligible for HIPAA (Health Insurance Portability Accountability Act). In Maryland, the state high-risk health insurance pool, the Maryland Health Insurance Plan (HHIP) has been designated as the guarantee-issue option for individuals exercising their HIPAA rights.

You may be eligible for the Maryland Health Insurance Plan if you are a resident of Maryland and:
- Are not eligible for group health coverage, COBRA, the Maryland Medical Assistance or Children's Health Programs, Medicare or any other government-sponsored health insurance program;
- Have exhausted all available group coverage or moved into Maryland from another state's high-risk pool;
- Have, or have been offered, health insurance that provides limited or restricted coverage, or that excludes coverage for a specific medical condition or conditions;
- Are receiving a federal Trade Readjustment Allowance or unemployment benefits under the Trade Adjustment Assistance program, or receiving pension payments from the Pension Benefit Guaranty Corporation; or
- Have been refused individual health insurance for medical reasons or have a specified medical condition.

Sincerely,

Amir

[starburst01]

Thanks, Amir.  This is exactly what I need.