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August 21, 2004

Insurance/Costs

Question from Atlanta, Georgia, USA:

My five year old was diagnosed 11 months ago with type 1 diabetes. We have been covered by BCBS (Blue Cross Blue Shield) of Georgia through my husband's job. He wants to start his own company now and we have found that BCBS of Georgia does not want to cover her under an individual policy. We would not qualify for Medicaid. Another option is Peachcare for Kids, but, from what I have read, we don't qualify for that either? What can we do?

Answer:

You are smart in planning ahead to avoid any lapse in health insurance coverage. It is unlikely that an insurer or HMO will offer coverage for your family because the policy or contract would be evaluated for underwriting. You may have several options for insuring your family through a group plan, but you will need to evaluate each one carefully. One option would be to continue with your current group coverage from your husband’s current employer through continuation rights guaranteed through COBRA. You have the option of up to 18 months of continuation, but you will have to pay the full cost of the coverage plus an administrative fee of between 2% and 5%.

Your family might also be eligible for a guaranteed issue conversion policy as a benefit through your current group health coverage. Another option would be to investigate if any professional or business association that you might belong to has an insurance program. These programs often have more limited levels of the things they cover or high deductibles to keep their premium costs down. You might even find that it would be worth while to join such an association just to have access to their insurance program. To learn more about these possible issues, I recommend you check out a health insurance information clearinghouse sponsored by the Georgetown University, School of Health Policy.

DSH