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January 31, 2008

Insurance/Costs

Question from Cleveland, Ohio, USA:

My now 20-year-old son, who has had type 1 since he was seven, has decided, after learning he only has two years left on our insurance, to give up his dream of continuing college to the next degree. He is concerned because we cannot afford the $500 a month it would take to buy his supplies. His endocrinologist informed us of this policy today. Could this possibly be true? How will he get an education to pay for his condition if he can't go to school? Do all middle class kids with diabetes just go without insulin and supplies? How do they survive? I need to help my son. I have invested too much time and energy to give up now. Do you have any suggestions?

Answer:

Before anyone hits the panic button, let’s explore the many options available for continued insurance coverage. From your statements, I assume that under the provisions of the group health contract under which your family receives its coverage, your son will no longer be eligible for coverage in approximately two years. This can be because of age (most contracts place a limit on the age of a dependent who can be covered through the contract) or his student status (some contracts will only cover full-time students through their first three or four years of college). However, when your son’s eligibility for coverage as your dependent ends, he will have other opportunities to obtain health insurance beyond individual policies with exclusions for pre-existing conditions. But, there are some time limits to be aware of in order assure rights to continued access to comprehensive health insurance that are guaranteed by Federal law. First, your son is entitled to continue coverage in your plan through a right of conversion of the current group coverage to an individual policy through the current insurer, with no pre-exisitng condition exclusion. And, under the rights granted through the provisions of the HIPAA portability requirements, your son may be able to move into new coverage in an individual policy without a pre-existing waiting period. The Consumer’s Guide to Getting and Keeping Health Insurance in Ohio published by the Georgetown University School of Health Policy, is an excellent place for a detailed explanation of health insurance. Note, if your son resides in another state, you can look at The Consumer Guides for Getting and Keeping Health Insurance. With careful planning, there is no need to panic.

DSH