Health Insurance Hassles

I left Novell in Jan 2005, it's been almost a year and a half that I've been on sabatical. That means my COBRA coverage will expire soon. Some health insurance companies have options for unemployeed people to be covered, it's called direct pay. So I've surfed around and settled on Blue Cross Blue Shield.

There are four plans to pick from. You have the choice of HMO or PPO which means you have a primary care physician or you can pick your own doctors per visit with different coverage if you pick in- (100%) or out-of-network (80%). You also have your pick of a Basic plan or not Basic which means do you have perscription drug coverage or not. Prices for the four plans seem to be based solely on your age and zip code and for me range from $333 to $700 a month.

First off, the perscription drug coverage. The coverage is the same for either plan but it costs $162 extra for the HMO and $367 extra for the PPO. Since I'm not on any perscription drugs now I don't think I need to pay $2000-4400 for the coverage. The next difference is PPO vs HMO. The PPO costs more since you have more freedom of choice. Without perscription drug coverage that costs you $33 more, with drug coverage it's $172 more. But the PPO has a $5000 yearly deductible! and the HMO had none. So it's HMO basic for me, $333 a month, basically what I'm paying now for COBRA (though I currently have perscription drug coverage and a $1500 deductible).

While filling out the form I see there's a 180 day waiting period after you signup where you only have emergency coverage. If you can show continous prior coverage you can have the 180 day period waved. So I need get to a letter from my current company showing "Proof of Prior Coverage". I call the number I have for COBRA benefits at Novell and leave a message. I look at the fine print on the Blue Cross application and it says to wave the waiting period I must send in the proof with my application at least 63 days before coverage begins. Why 63 days? I don't know. Maybe because two 31 day months in row would be 62 days? That happens only in July and August. Why couldn't they just say 2 months? And if the coverage is continuous why have a 2 month period at all? I thought was doing good, working on this two and half months before my coverage ran out, now I'm in a bit of rush and have to finish this this week.

Novell got back to me first thing next business day and the woman I spoke with was very nice and seemed helpful. It seems everyone uses a different term for Proof of Prior Coverage but we settle that quickly. To print the letter she has to terminate me from the system; that sounds ominous. Apparently it won't change my coverage with Aetna, just in the Novell system. But they don't normally like doing it until a couple of weeks before coverage runs out. But she says she can do it now. Well not right now, because PeopleSoft is being upgraded. Maybe after the upgrade you won't need to remove someone from the system to print a report showing the period of coverage, I doubt it. So I get to wait another day or so then I can come in and pick it up. Fingers crossed.

Update: So it all worked out. PeopleSoft came up and Novell could print the letter but not before I paid up for all my coverage through end of July. So I called back Blue Cross and found out that I misunderstood the form. I don't have to send it in with 63 days lead time, I need to send it in within 63 days from end of coverage. That is, I need to send it in later and early July, after I've made my final payment is just fine. And I asked, I'm not the only one who has been confused by their phrasing.