Nashville Bound

Hey there,
I plan on getting to the US in the next couple of months. My fiance has medical cover through his work, but I will only be covered once we are married (which is fine!)

My concern is prior or ongoing medical conditions and how they are seen by the insurance people!

I am sure it will increase our premiums, but how does it all work, do I have to pay for any treatments. Basically, I have no idea how it all works out there. The NHS has shielded me from needing to know anything really!

Thanks

meauxna

IMO, your fiance should get on the phone with his benefits manager at work, and start asking some specific questions. What you want to know is so specific to his particular policy that we'd just be sitting here guessing.
Generally in a group plan, you are not shut out for a pre-existing condition. It will definitely increase the premium he is paying now (but will still be less $$ than anything you could get on your own).
There are "co-payments" and "deductibles" to learn about.. IE, what do you pay at the point of service.

Tell him to ask the benefit manager about your specific ongoing condition and what is covered.

AmerLisa

I may be mistaken, but an employer group health plan doesn't usually ask about pre-existing conditions? And the premium will go up because the husband has added on his wife?

Duncan Roberts

How long after you get to the US are you getting married? It could make a massive difference.

If you get put on his insurance, and its a group plan (which it should be), within 63 days your condition will not be an issue. You can use your NHS coverage to credit against the exclusion period, normally 12 months. Also, if your condition was diagnosed more than 6 months ago and you haven't been treated or received medical advice for it in the last 6 months, its not a pre-existing condition so won't be an issue.

If it is a group plan, which employer sponsored ones usually are, it is a flat rate for everyone regardless of conditions. You usually have the options of self, self + spouse and family which will all be increasing in price but the same for all employees. The amount the company pays towards that may be different but the base price wont be.

SanDiegogirl

You asked about what treatments you would need to pay for? Not knowing what your pre-condition is this is difficult to assess, but a good Group Health Insurance usually pays for most medical ailments - no cosmetic surgery of course.

As others have said Group Insurance is not so rigid when it comes to pre-conditions i.e they do not usually reject you because of them - although you might have a waiting time before the insurance company will pay bills for the pre-condition.

Most insurance plans have a deductible (this is the sum you have to pay before the insurance plan pays for medical bills), a co-pay (eg $25 dollars for a GP visit) and, for example as in my husband's plan, after you have paid your deductible, the insurance pays 80% of a bill and you pay the remaining 25%. There are of course, your monthly premiums, taken directly out of payroll. Everything has a charge - doctor's/specialist visits, prescriptions, hospital visits, Xrays etc, vaccinations.

As another responder has said you need to check the details of your fiance's plan.

anuny

Large Enterprises tend to have more than one insurance company, and additional riders. It could be no-pay like BlueCross BlueShield, some payroll deductions like GHI and nice deduction like Aetna None of them will add a premium for adding someone with pre-condition, if they do then the enterprise negotiated a bad deal.

Duncan Roberts

It's 100% policy and employer. No insurance policy is no-pay, the employer may cover it 100% but BC/BSQUARE isn't giving it away free. Also, every plan will add a premium for adding a person with a pre-existing condition, it won't be any more than for somebody without a pre-existing condition but it will be an increase in premium. That is unless its a family plan and another child or spouse is added.

anuny

You are Correct, my bad in wordings - Typically BC/BS was/is to folks in my Enterprise no deduction, I do not think (no personal clue) adding a spouse with diabetes is going to have one rate than a child with diabetes etc. To sum it up; Choose BC/BS and no deduction on payroll; GHI some; and Aetna a decent deduction. And then there are co-pays $20 per visit (and those of them who took Credit Cards, there were 20 miles )

Jscl

Your premium will increase because your coverage will go from single coverage to couple/family coverage. Some companies cover a higher percentage of the employee's premiums than the additional they pay for families, but if not expect the premium to go up about 50% when they add you on. (Obviously it will go up more if they cover family premiums at a lower percentage.)

The extra premium for pre-existing conditions will probably be small, if it exists at all - that would depend on the size of the company your husband works for and the pulling power they have with the insurer. If they do exclude coverage for a pre-existing condition it will be for a fixed period of time, usually six months or a year, during which time you would probably have to pay the "negotiated fees" for any treatment to do with the condition, which is a lot cheaper than you'd pay without coverage. Again though, this is all dependent on the plan your husband's provider has.

A word of warning though - make sure you are added to your husband's plan IMMEDIATELY you get married, as many plans will not let someone add coverage except at the time of a special event (marriage, birth...) or at a certain time of year when everybody renews their coverage. (I.e. if your company's renewal period is in October, and you got married in February, you could only join the plan in February or October, not for instance if you felt like waiting to August.)