From: Scott Maxwell <smaxwell(--nospam--at)engin.umich.edu>
Date: Sat, 4 Jun 2005 02:08:55 -0400 (EDT)
I assume by your message that you are currently employeed by some entity
(i.e. company) that provides you with health insurance (either which they
completely pay for or maybe you partly pay for). If so, then your
short-term solution (for 18 months at least) is to COBRA that insurance.
COBRA requires that all all employer provided (with some exceptions - more
on that in a moment) health insurance be available to you at nominally the
same premium if you have change of employment "circumstances" (i.e. you
lose your job for anything other than gross neglectigence [i.e. fired],
you quit, your hours are reduced so that you no longer qualify for health
insurance from the company [i.e. go part-time]). This is federal law.
The main exception is if the company is below a certain size (i.e. I
believe 20 people). If you can COBRA your health insurance, then the cost
will be at the maximum the same as what your company pays (maybe with you
contributing some) for premiums plus at most a 2% admin cost. In
otherwords, your company can charge you at most 102% of the premiums that
they currently pay. The way it works is that the company keeps you on
their group policy for 18 months past your "qualifying" event (i.e. when
you quit) and you then must pay your company those premiums.
This is an important thing for some. It allows them to keep quality
health insurance at prices that they could not necessarily get otherwise
if getting an individual policy. For people with pre-existing conditions,
this can be a major thing. COBRA allows me to maintain insurance that I
would not otherwise be able to get that covers my pre-existing conditions,
including my prescription costs (which is the major thing that I can not
get through an individual policy at reasonable prices...and my
precription costs are significant). Now, if you are a healthy person
(i.e. you maybe get an occassional cold or flu etc) and your dependents
are healthy (i.e. you don't have some young boy or girls that just insists
on breaking bones doing "adventurous" things etc), then COBRA many not
matter to you. You could likely find cheaper individual policies that
cover major items (i.e. that broken arm, the birth of a child, some
unexpected hospitization, etc), but not the more "routine stuff".
So, that can get you 18 months while you explorer other options. So, you
could start your individual practice with the same insurance that you
currently have, but then start to look at other options.
If you like/want the same level of coverage as your group/employer
insurance once those 18 months are over, especically if you have some sort
of pre-existing condition that is currently covered, then HIPPA (another
federal law) will allow you to find health insurance at the same coverage
level (not necessarily including prescriptions coverage
though...prescriptions coverage is usually a "rider" anyways) that covers
pre-existing conditions...but just not necessarily for the same cost. Nor
does it necessarily need to be a "reasonable" cost. It is just there to
force health insurance companies to provide you with an individual policy
that covers your pre-existing condition (which will likely be expensive
for them)...if left to "market conditions" (i.e. capitalism), health
insurance companies would drop people who are "expensive" to cover (i.e.
those that have the nerve to be sick) to help their bottom line. HIPPA
tends to work in one of two ways depending on how your state chooses to
impliment it...1) all insunance companies must offer HIPPA "coverage"
(thus, competition keeps the individual policy prices for HIPPA "coverage"
moderately reasonable) or 2) the state negotiates with one or a couple
insurance companies to provide individual HIPPA policies at moderately
reasonable prices. The later is how Michigan operates. When I can not
longer COBRA my group policy, I will be able to get BCBS coverage that
covers that same things (i.e. my pre-existing condition) at actually
reasonable prices (just won't cover my presciptions that I must take).
This can then take care of things "beyond" the COBRA period. Just note
that HIPPA only applys when you make that first transition from a group
policy to an individual policy. If you are on an individual policy but
choose to go to another individual policy, my understanding is that HIPPA
no longer applies. So, those with pre-existing conditions have very
Now, if you don't have any pre-existing conditions, then you don't need to
worry about HIPPA and don't necessarily have to worry about COBRA. The
decision on COBRA will largely be a decision of what type of coverage do
you want. If you just want some form of "major medical" (i.e. covers just
major things like unexpected hospitizations), then more than likely COBRA
will be "overkill" as most group/company policies are HMO or PPO style
So, beyond COBRA and HIPPA stuff, there are policies that are psuedo-group
(technically they still individual policies that are slight negotiated
through a common group) policies through things like professional groups
(i.e. ASCE or NSPE), local small business groups, or other "like-minded"
groups. These will be policies that are arranges through some group that
has negotiated some price advantages.
You can also take to insurance agents. They will be able to get quotes
from various insurance companies for you and for various types of policies
that have different levels of coverage and different copays/deductibles.
And you can likely talk directly to insurance companies.
Beyond all that, your indiviudal state may have some laws that require
certain other minimum levels of available plans, etc. So, it might be
worth calling the state or searching their webpage (of course, finding the
right department/person to call/talk to could take some work).
On Fri, 3 Jun 2005 RainCat1(--nospam--at)aol.com wrote:
> I'm thinking of practicing on my own. For those of you in private practice,
> where do you get your health insurance? Any suggestions?
> Rainier Catubig, S.E.
> San Diego, California
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