How to claim creditable coverage
Dear friendly expats,
I am moving to Boston in 11 days (argh!/yay!) on a J-1 visa to take a twelve month research post. It's UK funded so I don't qualify for employee insurance and have paid for a J-1 fulfilling insurance plan from HarbourGroup insurance. They have said that they don't cover pre-exisiting conditions for 12 months, (which I do have, alas) but they also describe creditable coverage. If I get a letter from my GP saying I have NHS-cover, yadayadayada.... Then can I make the insurer give me some sort of letter stating they WILL cover my pre-exsitings? The wording in the contract is as follows.. "Pre-existing Condition means any condition for which medical advice or treatment was received or recommended within the six months immediately preceding Your effective date of coverage. This exclusion applies for 12 months after Your effective date of coverage. This exclusion does not apply to a pregnancy existing on Your effective date of coverage. This policy shall credit the time You were previously covered under a previous health insurance plan or policy or employer provided health benefit arrangement, if the previous coverage was continuous to a date not more than 63 days prior to the effective date of the new coverage. Such credit shall apply to the extent that the previous coverage was substantially similar to the new coverage. The creditable coverage outlined above means any prior health care coverage as defined in HIPAA which includes group coverage; individual coverage; Medicare; Medicaid; military service related care; Indian health service or tribal organization coverage; state health benefits risk pool; a public program offered under the Federal Employees Health Benefits Program: a public health plan: and Peace Corps Act Health Plan; state children’s health plans (S-CHIP); and foreign national health plans (this includes those health plans maintained by foreign governments, not just insurance coverage through a carrier in a foreign jurisdiction)." How shall I proceed? Thanks very VERY much, Best wishes, Athalia |
Re: How to claim creditable coverage
You don't really need to do anything unless or until you either make a claim and it is denied because the insurer believes that it was a preexisting condition or they specifically ask you for evidence of prior creditable coverage.
If and when that happens you tell them that immediately before being enrolled in their plan you were resident in the UK and covered by the NHS. Often that is sufficient. If they want more evidence than that then you need to find out exactly what it is that they *do* want. I'm not sure that a letter from your GP in the UK would be either necessary or sufficient. |
Re: How to claim creditable coverage
Originally Posted by md95065
(Post 10810388)
You don't really need to do anything unless or until you either make a claim and it is denied because the insurer believes that it was a preexisting condition or they specifically ask you for evidence of prior creditable coverage.
If and when that happens you tell them that immediately before being enrolled in their plan you were resident in the UK and covered by the NHS. Often that is sufficient. If they want more evidence than that then you need to find out exactly what it is that they *do* want. I'm not sure that a letter from your GP in the UK would be either necessary or sufficient. If you get a letter from your GP saying you were covered under the NHS for X number of years then call your insurance company and get the fax number, or secure email address, of the department you need to send it to and then send it. You likely won't get any sort of confirmation other than claims not being denied although a customer service rep should be able to confirm that the clause has been removed. I would recommend doing it sooner rather than later because it's just easier when you have medical conditions and need things associated to them. |
Re: How to claim creditable coverage
Originally Posted by md95065
(Post 10810388)
You don't really need to do anything unless or until you either make a claim and it is denied because the insurer believes that it was a preexisting condition or they specifically ask you for evidence of prior creditable coverage.
If and when that happens you tell them that immediately before being enrolled in their plan you were resident in the UK and covered by the NHS. Often that is sufficient. If they want more evidence than that then you need to find out exactly what it is that they *do* want. I'm not sure that a letter from your GP in the UK would be either necessary or sufficient. |
Re: How to claim creditable coverage
Originally Posted by Michael
(Post 10810573)
You have to declare your preexisting conditions at time of application and this determines whether you are in a high risk pool, the premium cost, and the coverage. If you don't declare preexisting conditions, the insurer will likely not pay.
|
Re: How to claim creditable coverage
Originally Posted by Duncan Roberts
(Post 10810557)
.. but it sounds like maybe md95065 hasn't had to deal with the nightmare of having things not covered and needing to prove creditable coverage ...
The whole thing took about 6 weeks to sort out and required 3 or 4 letters and hours on the phone with them :frown: |
Re: How to claim creditable coverage
Originally Posted by Athalia
(Post 10810292)
They have said that they don't cover pre-exisiting conditions for 12 months
http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html |
Re: How to claim creditable coverage
I directed the OP here :) (Waves!)
Can anyone locate tracym's fantastic thread started in (approximately) 2008 or 2009? I've searched and searched all over the forum, but can't find it. Thanks! |
Re: How to claim creditable coverage
Originally Posted by md95065
(Post 10810388)
If and when that happens you tell them that immediately before being enrolled in their plan you were resident in the UK and covered by the NHS. Often that is sufficient. If they want more evidence than that then you need to find out exactly what it is that they *do* want. I'm not sure that a letter from your GP in the UK would be either necessary or sufficient. BW |
Re: How to claim creditable coverage
Thanks to everyone for replying so quickly!
Hi there "Ozziedoc" wink wink! - Thanks for introducing me to the colossus of information here! I'm going to see if I can get confirmation that the clause can be/is removed before I travel. But I'm a bit worried about the line that says substantially similar coverage - does this mean they can get out of covering me by saying that the cover was not similar? 10 days till I fly! YAY! Any Bostonian expats out there?? Best wishes, Athalia |
Re: How to claim creditable coverage
Originally Posted by Athalia
(Post 10810964)
Thanks to everyone for replying so quickly!
Hi there "Ozziedoc" wink wink! - Thanks for introducing me to the colossus of information here! I'm going to see if I can get confirmation that the clause can be/is removed before I travel. But I'm a bit worried about the line that says substantially similar coverage - does this mean they can get out of covering me by saying that the cover was not similar? 10 days till I fly! YAY! Any Bostonian expats out there?? Best wishes, Athalia |
Re: How to claim creditable coverage
Originally Posted by Ozzidoc
(Post 10810709)
I directed the OP here :) (Waves!)
Can anyone locate tracym's fantastic thread started in (approximately) 2008 or 2009? I've searched and searched all over the forum, but can't find it. Thanks! Not a thread but this is the info Tracey sent me back in 2009: The HIPAA final rule: http://www.dol.gov/federalregister/P...px?DocId=10270 The rule was changed to specifically include foreign government plans such as the NHS. Also, it specifically says that a a certificate of creditable coverage is NOT required - just some reasonable proof (e.g. national insurance card, letter from doctor, etc.) Search the document for the word "foreign" for applicable text. Shorter version - here is a comment from Blue Cross/Blue Shield, which specifically mentions that the the law changed to include plans such as the NHS as creditable coverage. http://www.bcbsil.com/PDF/legislative_update_405.pdf FAQs address the fact that a doctor's letter or some such can suffice if a certificate of creditable cover is not available: http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html I have gotten this to work with a private insurer, and also for another person, it was accepted by a state high risk pool. I believe it used to be a problem, but now the law has changed. Sometimes one has to point out the law, as not all insurers are aware of it (the state high risk pool wasn't) - but they were glad to oblige once it was pointed out to them. I hate to see ths as an ongoing issue - as I do truly believe it is ok now. |
Re: How to claim creditable coverage
What the insurance company want to see will be up to them. A letter from GP or health authority is usually enough, but you need to ask them first what they will accept.
Worse comes to worst, you might be able to get on the MA Health plan, though I thought you had to be a MA resident for 12 months to first qualify, some people have said they haven't needed that but it affected the rate. |
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