Insurance Agent Forum

[Krono]

If someone is coming off of a group plan onto an individual plan, how does the Cert. of Credible Coverage help them? No waiting periods? Easier underwriting?

[somarco]

The certificate allows them to bypass waiting periods on pre-ex if they transfer from one group plan to another without a break in coverage. In most states it means nothing if you are going from group to individual.

[newmindfashion]

Just to add to that (in some states at least), if you go from Group to Individual and the carrier accepts the condition without putting an exclusionary rider on it, then the Individual plan must credit the time served on the prior coverage against the waiting period on pre-existing conditions. In my primary states, this also goes for individual to indiviudal.

Bob, is that not the case in GA?

[healthagent]

For indie plans like Aetna it means all the difference in the world. With prior credible coverage the 12 mo. pre-ex period Aetna imposes for any condition treated in the last six months is waived. Other carriers give partial credit towards pre-ex waiting periods.

[somarco]

HIPAA rules for individual to individual, or group to individual, do not apply in GA. Some carriers (as you mentioned) give credit for prior coverage. To my knowledge only Aetna & Consumer Life do so in GA.

Unless you are applying as a HIPAA eligible, the regular underwriting rules apply and riders, rate ups or declines will apply.

[K-Dub]

I remember running across a website that list all the state mandates and waiting periods etc. in regards to health insurance.

Anyone know of a website that does this??

[salpro22]

Don't know about a website but here are is a file I came across. If you find the website I would like to get it.

-J.R.

[Krono]

Apparently the Cert. allows credit towards waiting periods in TX for individual plans also.

[somarco]

Kris -

The problem with websites is you don't get carrier specifics. Kaiser gives a lot of good general info but weak on what actually happens from carrier to carrier.

In GA Aetna & Consumer give credit for prior coverage. Covington may, just can't recall at this time.

The other carriers don't care if you had prior coverage or not if you are applying to be underwritten.

[newmindfashion]

JR,
Cool PDF, thanks.

[BKrocko]

Try this one - http://info.insure.com/health/lawtool.cfm

I got it off of this forum but do not remember who posted it.

[trvlnut]

Originally Posted by john_petrowski

For indie plans like Aetna it means all the difference in the world. With prior credible coverage the 12 mo. pre-ex period Aetna imposes for any condition treated in the last six months is waived. Other carriers give partial credit towards pre-ex waiting periods.

I have a client whose group plan was cancelled. She won't have insurance for 30 days. Will the prior credible coverage still apply since she didn't have a 63 day lapse?

Thanks,
Nesha

[newmindfashion]

Nesha,
Should be no trouble at all. In some cases, carriers will allow 120 day breaks and 150 if due to involuntary loss of employment. 63 is usually the norm though.

[trvlnut]

Thanks for your help Newmind!