Moving Your Health Insurance? Be Sure To Have Mental Health Coverage, You’ll Need It.

I had a little difficulty finding a good image for this sort of "grandfathering"

As I have explained beginning here, in the process of trying to move from Kentucky to Maryland, I was horrified when I received information in the mail from CareFirst  (the Blue Cross company that operates in Maryland) telling me that the health insurance policy they would give me with Blue Cross Blue Shield’s guaranteed transfer program had a maximum lifetime benefit of $250,000.  I contacted CareFirst by phone and was told that the information was accurate and allowable because it was what is called a grandfathered policy (see below for the definition of this kind of policy) and not subject to the new health care rules.  That however is not true in the case of lifetime limits. Here is the official government explanation (emphasis mine):

  • Under the new law, lifetime limits on most benefits are prohibited in any health plan or insurance policy issued or renewed on or after September 23, 2010.
  • The new law restricts and phases out the annual dollar limits that all job-related plans, and those individual health insurance plansissued after March 23, 2010, can put on most covered health benefits. Specifically, the law says that none of these plans can set an annual dollar limit lower than:
    • $750,000—for a plan year or policy year starting on or after September 23, 2010 but before September 23, 2011.
    • $1.25 million—for a plan year or policy year starting on or after September 23, 2011 but before September 23, 2012.
    • $2 million—for a plan year or policy year starting on or after September 23, 2012 but before January 1, 2014.
  • No annual dollar limits are allowed on most covered benefits beginning on January 1, 2014.

Some Important Details

  • Be aware that plans can put an annual dollar limit and a lifetime dollar limit on spending for health care services that are not “essential.”
  • If the new rules apply to your plan, they will affect you as soon as you begin a new plan year or policy year on or after September 23, 2010. (For example, if your policy has a calendar plan year, the new rules would apply to your coverage beginning January 1, 2011).
  • If you have a “grandfathered” individual health insurance policy, your health plan is not required to follow the new rules on annual limits. (A grandfathered individual health insurance policy is a plan that you bought for yourself or your family; that you did not receive through your employer; and that was issued on or before March 23, 2010). If you’re not sure whether your plan is grandfathered, ask your insurance company.
  • The ban on lifetime dollar limits for most covered benefits applies to every health plan—whether you buy coverage for yourself or your family, or you receive coverage through your employer.
  • Some plans may be eligible for a waiver from the rules concerning annual dollar limits, if complying with the limit would mean a significant decrease in your benefits coverage or a significant increase in your premiums.

If that wording is not clear enough, this wording from a 2010 Health and Human Services fact sheet certainly is:

All health plans – whether or not they are grandfathered plans – must provide certain benefits to their customers for plan years starting on or after September 23, 2010 including:

No lifetime limits on coverage for all plans;

So grandfathered or not, given that CareFirst is issuing me this plan in 2011, a plan with a $250,000 lifetime limit was not legal.  I sent a query to the Maryland Insurance Administration regarding this and lo and behold, CareFirst sent me an Amendment to the policy that gets rid of the limit.  They couldn’t find any record of anyone at CareFirst telling me that there was a $250,000 limit.  Really?  Maybe they don’t actually record all those conversations for training purposes.  And who do they think sent me the policy information sans amendment in the first place that triggered complaints being filed in two states and with numerous elected officials not to mention the launch of this blog?

There is however another huge flaw in the policy they are offering me–according to the plan description, there is no cap on out of pocket expenses which obviously could add up to a huge chunk of change with a serious health event.  As far as I can tell, it is the only policy they offer that does not have a cap (but I’m not eligible for those plans because I have so-called pre-existing conditions).  In this case, the clause may be legal under the “grandfather” definition, but it sure isn’t right and a reprehensible change  to make to someone’s coverage simply because they moved, which I have pointed out to the Maryland Insurance Administration, which gives itself 90 days to respond to complaints, so sit back and relax, we’re going to be here awhile.  If in fact they are allowed to do that, it would be tantamount to a blatant effort to get me to transfer to the Maryland high risk plan (MHIP) when I become eligible (you have to live in Maryland for 6 months which I am still a few months shy of).  It would be a cushy deal for CareFirst which administers MHIP–so they get their fees for administering my health insurance, but none of the risk.

Meanwhile back in Kentucky…

After I initiated the policy transfer between the two Blue Cross’ and found out that the new policy was not what I had been led to believe would be available, I contacted my agent in Louisville who had sent me the misleading information about insurance in the DC metro area to begin with (documented in my first post)  and told her it had put me in quite a bind. She told me that one option, if I maintained dual residency in Kentucky is a plan that they offer that is a national plan designed for people who might be working somewhere else temporarily or be retired with homes in two states or similar situations. It is called Blue Card and looks like what every insurance policy should look like (all 100 plus pages of it)—namely, insurance, regardless of where you live.

At her suggestion, I sent Anthem a letter asking to stop the transfer which they granted.  However they forgot to tell me they had stopped the transfer and apparently also forgot to tell their own Grievances and Appeals department which, in responding to the complaint I had filed with the Kentucky Department of Insurance, said that while they “empathized” with me, as far as they were concerned, I had moved and was no longer a customer.  I only found out from the letter that my insurance agent sent to the Kentucky Department of Insurance explaining that it had been stopped.  Since the Grievance and Appeals letter was dated after the letter from my agent, I assumed that was the last word and that maintaining dual residency and keep the better insurance available from Anthem in Kentucky was not an option.  But I assumed wrong.  When I called Anthem to make sure they would not deduct my premium from my checking account for the upcoming month, when the transfer was supposed to happen, it seems that I am still a customer and the transfer was stopped.  And presumably no one has told CareFirst which has already billed me for my new insurance!  Confused?  I sure am.

The thing that that I keep coming back to is that none of this should ever have happened.  Moving your insurance should be no more complicated than the change of address form you fill out to forward your mail and.  Instead, it has proven to be an epic farce of Frank Zappa proportions.

    • b
    • September 29th, 2011

    And this while the numbers of the uninsured are ballooning. Single payer, anyone?

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