Saturday, October 09, 2010

ObamaCare© Dreamin': I've got some questions

Currently, and since the advent of HIPAA, I can go from a group plan to another group plan, or an individual plan to a group plan, on a guaranteed issue basis, and any pre-existing conditions will be covered immediately.

[ed: Yes, there are a variety of hoops through which to jump, but assume those for sake of discussion]

In order to accomplish this, I need but a simple piece of paper, called a Certificate of Creditable Coverage, which "proves" that I've been covered for (at least) the previous 12 months. Absent this Cert, my new employer's carrier can delay covering any pre-existing conditions for a while.

Yes, yes, Henry. What's your point?

Well, as long as I have that little piece of paper, I can prove prior coverage, which is the point of the exercise, and demonstrates that one can, in fact, prove a positive.

But can one prove a negative?

Implicit in the PCIP (ObamaPool©) program is the applicant's assertion that he has not been insured during the previous six months. Which leads us to Question #1:

How does the Pool's© lifeguard prove that I did?

Follow up question: by what mechanism is the new carrier allowed to investigate the veracity of my claim?

Next, we turn our attention to the problem of the child; that is, the fact that one can no longer buy a child-only policy. Carriers which have gone this route (and I'm aware of none that haven't) generally allow a child to be covered if at least one of his parents is also on the policy. Which brings us to Question #2:

What happens when Mom and Junior apply and are issued a policy, and a month later Mom drops coverage on herself?

Follow-up question: by what mechanism would the carrier be allowed to then cancel coverage on Junior?

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