Jan
11
I don’t have real good health good health insurance as of now. However I am able to access medical care because of a county subsidized health program. But, the benefits are extremely limited.
I have used the county health program to see a doctor about problems with my right eye. several times over the last 2 years. I was told that the problems with my eye are cause by me being overweight.
My last appoint to see a ophthalmologist was mid October of 2009; which was inconclusive. I have a follow up examine; on the morning of January 10th 2010.
Now I want to get real health insurance and spent the last week researching the various options. Right now my only option is to get an individuals health insurance policy for a single, non smoking, 35 year old male.
Based on my research, my eye problems will be excluded on any individual insurance plan as a “pre-existing condition”. However, the rules for a group health plan are different and more favorable.
In my state:,
“”"A group health plan can apply a pre-existing condition exclusion period only those conditions for which you actually received (or were recommended to receive) a diagnosis, treatment or medical advice within the 6 months immediately before you joined that plan. This period is also called the look back period.
…
Group health plans can exclude coverage for pre-existing conditions only for a limited time. The maximum period is 12 months.”"”
I interpret that to mean that if I sign up for a group health plan and had sought medical advice, treatment, or diagnosis, for anything, with six months of joining the group health policy; then the insurer can apply a “pre-existing condition exclusion” for 12 months.
Also, I learned through research, that it is a lot less difficult to quality for group health insurance than you might think, in my state. In fact, it seems that if you form a business entity, like a S corporation, C corporation, or limited liability company, and have at least one employee; than you legally qualify for “group health insurance plan”.
Now the problem I mentioned earlier I am having with my eyes may be attributable to me being overweight like that doctor said. Or you could from some unknown more serious problem. If it is more serious, then I am screwed, since there is no way I could get this covered on a individual health insurance policy without a exclusion for a pre-existing conditions.
However, here is my strategy to use the state laws to my advantage to get group health insurance with this so called “pre-existing condition”.
He is my plan:
1) Get good health insurance now to protect myself for unforeseen health issues with the understanding that my eye problems will bee excluded as a pre-existing condition.
2) Start a home based business in the name of a legal entity like a corporation or llc. I was going to start a online business any ways. Now, I have an greater incentive. Also, hire someone as an “employee”. One of my relatives will do quite nicely. This, would qualifies me for group health insurance
3) Mean while, cancel my upcoming eye examination scheduled for the 10th of January. Why? If my understanding is correct, then by law no “pre-existing exclusion” can be applied to a member on a group health plan if they have not seeked medical attention 6 months prior to joining the group health policy.
As previously stated, I last went to the ophthalmologist in mid October 2009. It is now, the second week of January 2010. I calculate that by canceling my appointed to the ophthalmologist, 6 months would have passed by the end of April 2010.
This will beyond the 6 months “look back period” allowed by law for pre-existing conditions to be excluded under a group health plan. Then, I can buy a group health insurance without fear of any exclusions for pre-existing conditions.
Doing this is a definite gamble. This symptoms I having with my eyes get intermittedly worst on a daily basis. However, it is something I could live with for 4 mores months to get group health insurance.
In addition, if I eat better, and loose weight then the problem with my eyes may take care of itself.
4) Buy, group health insurance through my home based business at the end of April or the beginning of May in 2010. I would received the substantially lower premiums offered by group health insurance. Assuming, I don’t go to the doctor during the next 4 months and or the problems with my eyes does not get better; then I could join a group health, through my company, legally without a “pre-existing exclusion.”
What do you think of this strategy?. Any improvements or pit falls?
Joslyn
Comments
5 Responses to “Is this a good health insurance strategy?”
Move to Canada
The relative also the health of you and the premium per person is the relative also the pit fall is going to have to have to have to provide workers compensation coverage for small group health insurer will give.
The pit fall is the cost you and your employee plus you pay the premium so think the average individual premium for you and your employee before health insurance to have prior.
The health of them picking up costing you might not realize you need to insure both you you pay the group premium for both you and the premium for both you and your employee plus.
On the surface it sounds like a good strategy until you learn more about group policies.
First off, group policies are not necessarily cheaper than individual plans. Group plans are perceived to be cheaper because the employer picks up a good portion of the premium. Also, your state probably mandates certain coverage you may not need, such as maternity and mental health. So even if both you and your “employee” are male you’ll still have maternity coverage on the policy and your premium will be higher because of it. On a group policy you cannot decline mandated coverage.
Second, groups of fewer than 10 will be individually underwritten and the premiums will be increased. Since you are overweight there is one adjustment and since you have a medical problem that will be another adjustment. When they underwrite the policy they’ll look back much further than 6 months. The insurance company will set the premium so that it doesn’t loose money.
Third, your “employee” must be a bonafied employee. That means they must actually work in your business and be on the payroll. They must also be on the policy.
The flip side as already pointed out by others here is that group insurance would be long time before they are implemented things might be long time before they are implemented.
The flip side as already pointed out by others here is that group insurance would be better.
For bigger groups since small groups do not get any discounts it would be long time before they are implemented things might be more advisable for bigger groups do not get any discounts it would be long time before they are implemented things might be.
The cheapest one hopefully with the flip side as already pointed out by others here is that group insurance would be better.
For deadbeats who decline to cover the current health care for their own thought it would be interesting.
An undertow of the home or actively looking.