If your company switches insurance companies, can the new company deny,

[Deja Q]

despite an open enrollment cafeteria plan? Aren't they supposed to take people under these circumstances?

[endarkenment]

1. currently it is entirely between your company and the insurance company

I do not believe there is any national regulation requiring coverage, or preventing exclusion of pre-existing conditions. Some states may have state regulation that control this.

Again note how at odds the reality of the common experience of our health insurance system is: we have no choices, our 'options' are dictated to us by our employers.

[Deja Q]

2. Yup. That sounds like freedom, all right...

(not)

[Statistical]

7. Not true. For a plan to be tax exempt it needs to meet certain criteria.

Sure a company can offer any kind of crazy fucked up plan they want but then it isn't tax exempt per IRS rules which no employer wants.

[endarkenment]

11. So what are the rules?

Seems to be pretty well hidden behind a maze of web indirection.

[Statistical]

12. For tax exempt plans (i.e employer plans)...

The plan can no have pre-existing coverage exclusion. In otherwords they must accept every single employer regardless of their condition, age, or health.

The plan CAN however have an up to 12 month period in which pre-existing conditions are not covered.

However that 12 month period is reduced by the amount of time an employee has credible continuous coverage. HIPAA allows breaks of up to 69 days without losing "credible continuous coverage".

So if you have insurance for 12+ months then assuming you have no break in coverage (70+ days) any tax exempt plan can not deny coverage for pre-existing conditions.

This applies universally for all employer based plans because if the plan doesn't meet these conditions it is TAXABLE. For a major employer like say Walmart which spends $2B a year on healthcare losing tax exempt status would mean $700 million in extra taxes. No employer is stupid enough to pick a plan which doesn't meet HIPAA requirements. They aren't doing it because "they care" they are doing it because it is INSANELY costly to not have a compliant plan.

[donco6]

3. We've switched several times and I've never seen that happen.

But that doesn't mean it couldn't.

[Deja Q]

4. True... I am, in all likelihood, being "preemptively paranoid".

And I've been wrong plenty of times before. :)

[donco6]

5. When we've talked about it in our ins. committee -

- we've always made that a criteria for accepting any new company. "Will they take all existing employees?" But I suppose some company might not be that magnanimous - but DAMN, they'd have to be pretty cold-blooded.

[Statistical]

6. No. To be tax exempt the plan has to have no pre-existing limitation.

The key is "continuous coverage".

So if you were covered by the old plan for 12+ months and the company changes plans the new plan can not have any pre existing condition limits.

Companies aren't doing this to be nice. If they violate plan rules the plan becomes no-exempt. Suddenly the entire benefit amount is taxable. For a large company that can be hundreds of millions in extra taxes.

http://en.wikipedia.org/wiki/HIPAA

It has been that way since 1996.

[Deja Q]

8. "Plan" as in "provider"? We're getting Blue Cross Blue Shield, absconding the more costly provider.

Thank goodness for HIPAA. It was one of the best things President Clinton did.

[Statistical]

9. Well technically the provider can do what they want.

However if the insurance plan offered doesn't meet certain criteria then the company (your employer) loses tax-exempt status for the plan which would cost your employers millions, maybe hundreds of millions in extra federal & state taxes.

Because of that it is "defacto" that all plans offered by all providers meet certain criteria (limits on plan restrictions for pre-existing conditions being one).

Why would an employer want to pick a plan that costs them hundreds of millions in extra taxes?

HIPAA gets a bad wrap but it does do some good things. Sadly it didn't go far enough but things would be much worse without it.

Note: under HIPAA a plan can have "limited" pre-existing coverage denial
I am no lawyer but this is my understanding. A plan ca limit coverage for pre-existing conditions for up to 12 months. However an employee can have that limit waived by showing "continuous" coverage under a previous plan (employer old plan, previous employers plan, spouses plan, etc).

So as long as you have coverage as long as your coverage does not lapse more than 69 days no other employer plan can deny coverage for pre-existing conditions. If you coverage does lapse 70+ days then they can but only for first 12 months.

Once again... not a lawyer that is just my layman understanding of HIPAA.

[Thickasabrick]

10. I would say no, the provider would not have a chance in hell of

gaining the new employer if they had policies like that - unless it was a really, really bad employer. Agree with the tax-exempt rules too.