Health Insurance

Even though USNA69 answered Zaphod's question about VA I'll expound a little on that as well as the insurance aspect. Midshipmen/Cadets who are medically dis-enrolled from an academy are not eligible for VA care or disability. Not sure exactly what this falls under, but it’s there.

As for the insurance, having had to play w/Tricare with Midshipmen when it was first rolled out, there was/is a lot of confusion by the Midshipmen (I don't know if its covered a little more clearly now in briefings or not) about how they go about getting civilian medical care if injured while at home on vacation/leave. These are smart kids (that’s how they got to the academies in the first place) but you get them home with Mom and Dad and they tend to forget a lot of stuff :shake:. For non-emergent care (i.e. threat to life or limb) they have to contact their primary care manager (PCM) or the 24 hour nurse line (they get a card with the numbers on it, and most throw it away) to request authorization for civilian care. If it’s an emergency then they have to contact their PCM or the nurse line within 24 hours of receiving care. If not, the Midshipman/Cadet can be found responsible for the medical bills.

If a Midshipmen/Cadet is still being carried on their parents insurance, the above rules still hold true, as Tricare will pay a portion of the bill and the private insurance will pick up the rest (all coordinated through Tricare). On I/R-day the Midshipmen/Cadets are asked about private insurance. If they are still being carried, then Tricare will bill a portion of any medical care they receive at the academy to the private insurance company, again, Tricare does all the paperwork.

If I get time today I'll dig around and see what I can find about the VA thing. Something in the back of my brain says it has to do with the fact that they are not really considered on active duty, but I'll dig around some more, or if someone who has that information please post it.
 
Given what we've seen on the news lately and based on six years of experience in dealing with veterans issues, I wouldn't want to rely on the VA.:thumbdown:
 
My memory can sometimes not be the best. Fourteen years ago when my plebe-to-be got his package, the Academy recommended that midshipmen consider retaining their prior health coverage. I perhaps misspoke above. The site I found recently was the parents site and not an official Academy site which recommended retention of said insurance. Therefore I am not sure what the official policy is that is now being promulgated.

Boss, I just read your bio. You stated that you were in the health insurance business. If a midshipman/cadet is disenrolled due to health issues, is over the age of 19, and his parents have continued coverage on the family health policy, how long will the now-disenrolled student be covered under that policy for the existing condition? If I remember correcly, it was situations such as this that the Academy recommended continued family coverage. I scanned the HIIPA group rulings but could not find anything definite.
 
Frankly I have been out of the health insurance loop for about five years so I'd prefer not to take a crack at that one. Some of this is dependent on state law, also on whether the employer is self-insured, etc. Best check with your individual company and/or state insurance department.
 
First - everyone should check it out with your own carrier. That being said - My understanding is that if a situation changes (lost coverage for whatever reason - including no longer at the Academy) the student has 30 days to notify old carrier (that family is still covered under) and reinstate, with no questions asked. If student is not within the age limits, they may need to enroll in school someplace, a community college would do, in order to keep that coverage. Under this scenario, if timely reinstatement is requested, they cannot be turned down. If they don't make the request within the alloted timeframe, then evidence of insurability may be required. This is assuming the plan they are returning to is a group plan (presumably through your employer). If it is an individual plan all bets are off and I have no idea what regulations are in place in that scenario. Also, there may be different factors in play if it is a "small group" vs. a "large group" plan.

In our situation (not necessarily your situations!) I confirmed with our small group carrier in California that if we remove D from our plan and she goes under TriCare and then is disenrolled from the Academy (thus also disenrolled from TriCare), they WILL take her back without any limitations for preexisting issues and they WILL cover any care she needs, even if she was injured while not under the coverage. I confirmed this very specifically verbally (and just because I am like this, I wrote a letter confirming my understanding today too!).

Disclaimner - though I am in the insurance industry - this is not my area of expertise and as such I spoke to my carrier. I cannot say if this would hold true with all carriers as a result of compliance with a regulation or if it is a company policy that my carrier maintains. I would not be surprised if each state has different regulations for this issue. Our cost savings by removing D from the policy will be $332 per MONTH so I am interested in doing that!

I recommend that everyone evaluate their situation individually because there are so many variables that your situation may be very different than ours. Some variables that easily impact it are: State, Size of Group, Individual vs. Group Plan, Insurance Carrier involved, Specific Terms of the policy etc.... If there were not a significant cost impact, I would not even consider taking D off our family coverage. In our case, the cost factor is significant so it is worth it to evaluate.

Bottom line - call your carrier and find out.
 
From http://www.dol.gov/ebsa/newsroom/fshipaa.html
The department of labor website:
HIPAA Protects Workers And Their Families By
  • Limiting exclusions for preexisting medical conditions (known as preexisting conditions)
  • Providing credit against maximum preexisting condition exclusion periods for prior health coverage and a process for providing certificates showing periods of prior coverage to a new group health plan or health insurance issuer
  • Providing new rights that allow individuals to enroll for health coverage when they lose other health coverage, get married or add a new dependent
  • Prohibiting discrimination in enrollment and in premiums charged to employees and their dependents based on health status-related factors
  • Guaranteeing availability of health insurance coverage for small employers and renewability of health insurance coverage for both small and large employers
  • Preserving the states’ role in regulating health insurance, including the states’ authority to provide greater protections than those available under federal law
Preexisting Condition Exclusions
  • The law defines a preexisting condition as one for which medical advice, diagnosis, care, or treatment was recommended or received during the 6-month period prior to an individual’s enrollment date (which is the earlier of the first day of health coverage or the first day of any waiting period for coverage)
  • Group health plans and issuers may not exclude an individual’s preexisting medical condition from coverage for more than 12 months (18 months for late enrollees) after an individual’s enrollment date
  • Under HIPAA, a new employer’s plan must give individuals credit for the length of time they had prior continuous health coverage, without a break in coverage of 63 days or more, thereby reducing or eliminating the 12-month exclusion period (18 months for late enrollees)
Your state may have a stronger law than HIPAA - the age limits of dependents vary according to state law and your policy.
This is the law that allows you to add your child BACK to your insurance if needed and within the age guidelines of your policy. Pre-existing conditions should not be a problem since your child had credible coverage.
 
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