HRO
02-16-2008, 02:44 PM
Hello, in 45 days or so, I will have exhausted my COBRA plan (18 months). I am currently going through the process of getting individual coverage for myself and my girls.
Recently, my youngest daughter had ear tubes put in her ears, however one has collapsed and may have to be redone, if she starts to have fluid build up again. The insurance company I applied with approved our application, however it included a Condition Specific Deductible Endorsement in the amount fo $6,000 in reference to any issues related to her hears (OTITIS MEDIA).
In addition, they added a $3,000 CSDE for my ADHD.
This is all in addition to our $5,700 deductible on a HSA plan. Unforeseen issues aside, I highly doubt we will even meet our 5,700 deductible for the year anyhow. Can they add on the CSDE for us, even though we have never had a lapse in insurance in the last 12 years (less for the girls, they have always been covered).
My guess is they can do this, but I just want to be sure. My wife has been denied by two carriers and thus is eligble for the state High Risk Pool. This is very expensive and the deductible is out of sight and chances are she will use it all. So, combined we will have around a 12,000 deductible, with another $9,000 for the girls and my specific CSDE, and another $7,500 70/30 for my wife, combined with around $800-$900 in premiums per month.
I was paying around $1000 per month for the whole family on a HMO style (but not HMO) plan that we just had co-pays, and that also included vision and dental... and I don't those last two included in my numbers above.
I figure I will be lucky if I keep my medical expenses below $2000-$2500/month including premiums for this coming year.
Anyhow, if anyone can just verify the CSDE when we have exhausted COBRA with no lapse in coverage, then I can not attack my insurance agent. ;)
Recently, my youngest daughter had ear tubes put in her ears, however one has collapsed and may have to be redone, if she starts to have fluid build up again. The insurance company I applied with approved our application, however it included a Condition Specific Deductible Endorsement in the amount fo $6,000 in reference to any issues related to her hears (OTITIS MEDIA).
In addition, they added a $3,000 CSDE for my ADHD.
This is all in addition to our $5,700 deductible on a HSA plan. Unforeseen issues aside, I highly doubt we will even meet our 5,700 deductible for the year anyhow. Can they add on the CSDE for us, even though we have never had a lapse in insurance in the last 12 years (less for the girls, they have always been covered).
My guess is they can do this, but I just want to be sure. My wife has been denied by two carriers and thus is eligble for the state High Risk Pool. This is very expensive and the deductible is out of sight and chances are she will use it all. So, combined we will have around a 12,000 deductible, with another $9,000 for the girls and my specific CSDE, and another $7,500 70/30 for my wife, combined with around $800-$900 in premiums per month.
I was paying around $1000 per month for the whole family on a HMO style (but not HMO) plan that we just had co-pays, and that also included vision and dental... and I don't those last two included in my numbers above.
I figure I will be lucky if I keep my medical expenses below $2000-$2500/month including premiums for this coming year.
Anyhow, if anyone can just verify the CSDE when we have exhausted COBRA with no lapse in coverage, then I can not attack my insurance agent. ;)