Aetna Credible Coverage

[KCinsuranceguy]

How does Aetna look at GI or mini med plans as far as credible coverage? Is it considered credible?

The customer I'm talking with has Nationwide health insurance; I've never heard of them but I think it may be a GI plan? The customer didn't know what the benefits were.
- - - - - - - - - - - - - - - - - -
Another thing. How do they verify the credible coverage? Does the customer have to send in the certificate of coverage to have pre-x covered or do they just go off of the application and verify internally?

 

[moonlightandmargaritas]

It's actually not credible, but creditable.

 

[somarco]

Nationwide does (or did) write individual major med in some states. Yours may be one of them.

They also write some group, so that could be a COBRA plan.

Mini meds are not creditable coverage with any carrier. Of course, try telling that to the bozo's who write AIM plans.

When your prospect terminates the Nationwide coverage they are supposed to send out a letter of creditable coverage.

Unless of course it is something that is not considered creditable.

 

[TXINSURANCE]

Creditable coverage rules vary from state to state.

Texas law requires individual be be considered creditable the same as group (if under 63 day gap), most states do not consider prior individual as creditable.

 

[bill3173]

Creditable coverage rules vary from state to state.

Texas law requires individual be be considered creditable the same as group (if under 63 day gap), most states do not consider prior individual as creditable.

I currently write in 3 states and at one point 5. I've never heard of indvidual major med plans not being creditable coverage.

 

[KCinsuranceguy]

Thanks guys.
Does the customer have to send in the certificate of creditable coverage to receive benefits on pre-existing or will the carrier verify this somehow?

 

[Crabcake Johnny]

Yes, when requested they have to fax or mail it in

 

[somarco]

Frequently Asked Questions about Portability of Health Coverage and HIPAA

If your last coverage was in a group health plan, you may want to sign up for COBRA continuation coverage. While you (and your family members, if they were also part of your prior plan) will have to pay for this temporary coverage, COBRA can prevent or reduce a break in coverage. (Learn more about COBRA.)

You can buy an individual health insurance policy if you think you would otherwise have a break of 63 days or more.

Some states have high-risk pools for people who cannot otherwise get health benefits. Your state insurance commissioner's office can tell you if such a pool exists where you live.


http://www.consumerallianceusa.org/glossary.html“Creditable Coverage” Benefits or coverage provided under:
1. A group health plan;
2. Health Insurance Coverage;
3. Medicare: Part A or Part B;
4. Medicaid: other than coverage having only benefits under Section 1928;
5. Military, TRICARE, or CHAMPUS;
6. A medical care program of the Indian Health Service or of a tribal organization;
7. A state health benefits risk pool, including the South Carolina Health Insurance Pool (SCHIP);
8. The Federal Employees Health Benefits Plan (FEHBP);
9. A public health plan, as defined in regulations;
10. A health benefit plan under the Peace Corps
11. Short Term Health; or
12. A State Children’s Health Insurance Program (S-CHIP)
This term does not include coverage for Expected Benefits. The Sponsor will count a period of Creditable Coverage without regard to specific health benefits covered during the period.

http://managedbenefitplans.com/glossary.htmlCREDITABLE COVERAGE: Creditable coverage generally includes period of coverage under an individual or group health plan not followed by a break in coverage of 63 days. Creditable coverage excludes liability, limited scope dental, vision, specified disease or other supplemental-type benefits.

 

[retread]

Thanks guys.
Does the customer have to send in the certificate of creditable coverage to receive benefits on pre-existing or will the carrier verify this somehow?

Do your due diligence: Kansas law provides publications that answer these and other questions. Missouri has them too. Don't expect others on the forum to do your homework for you. This is part of being a professional... I will offer you this from KID, but from now on, look up basic questions on your own:

Federal and state laws provide important consumer protections for those who have pre-existing medical conditions and move from one job to another. If you show proof that you were previously insured under a qualified health plan, you may not have to satisfy a new pre-existing condition waiting period with your new plan.

Changing coverage from one group plan to another

When you change from one group plan to another group plan, you must be allowed credit for the time you were covered by your former health plan. This credit, called prior creditable coverage, is “portable” in that it must count toward the pre-existing medical
conditions waiting period under your new group plan. You get a day of credit for each day you were insured under your former plan.

Qualifying for prior coverage credit

To qualify for prior coverage credit:
• You must have had coverage under a qualified health plan. Qualified plans include fully insured group or selfinsured employer health plans; individual health insurance; government health plans, such as Medicaid and Medicare; state and federal government employee health plans; coverage through state high-risk pools; and the Indian Health Service.
• You must not have a gap of more than 62 days between your former coverage and your new group health plan. (Your new coverage must be in place on the 63rd day to avoid a gap in coverage.)

Plans that do not qualify for “prior creditable coverage”

Ø You cannot get credit for coverage under such nonmedical
coverages as dental or vision plans, specified disease policies such
as cancer or disability insurance, long-term care insurance or
supplemental insurance such as Medicare supplement insurance.
Ø You cannot get credit moving from a group plan to an individual
policy unless you join the state’s high-risk pool (Kansas Health
Insurance Association).

Getting proof of prior coverage

All group health plans must give you a certificate that shows how long you were covered under their plan. The insurance company must provide you this certificate of prior creditable coverage when:
• You leave your job.
• You exhaust your COBRA or state continuation benefits.
• You ask for it within 24 months after leaving the plan.

Note: This is taken from the Chapter discussing Group Insurance. Please note that Individual Health Insurance is considered "creditable" in the state of Kansas, except when moving from group to individual without going through the high risk pool first. This is because Kansas law permits pre-existing conditions to be considered for IFP.

 

[KCinsuranceguy]

Do your due diligence: Kansas law provides publications that answer these and other questions. Missouri has them too. Don't expect others on the forum to do your homework for you. This is part of being a professional... I will offer you this from KID, but from now on, look up basic questions on your own:

Though I appreciate your information, I don't appreciate the tone and condescending manner you are using with me. This is a very complex industry to get into and I'm brand new as an independent agent with no manager. Let me guess you just took off running and never asked questions like this because you knew exactly where to find the information on your own without any help from anyone right?