Since they will be without insurance when the new insurance goes into effect, will they be exempt from any preexisting conditions?

Course: Employment Law: LGL-554-1606
Assignment: Assignment 5

Benny and Dora Brown are a married couple with two young children. On April 10th, They come into your office and tell you the following facts:

Benny is an independent contractor but his wife Dora is an airline Pilot. They were on Dora’s health insurance for themselves and their two children. Unfortunately, Dora lost her job on January 1st.

On February 28th, they purchased Temporary Insurance, because their two year old daughter liked the talking lizard in the ad. This temporary insurance is good for two months, lasting until April 28th. It has high premiums, but they are generally a very healthy family, and really only bought the policy in the case of something catastrophic.

Fortunately, Dora found a new job at a small airline company. The job, and the health insurance from her new employer, will begin on May 1st. They understand that they will be without insurance for a few days, but decided it would be okay.

As luck would have it, Dora is starting to experience some symptoms that may be somewhat serious. Not knowing what a “diagnosis” might entail, the Browns are considering their options. They are trying to weigh their rights and options as to whether to wait until the new insurance starts (approximately 3 weeks) or to have her go to the doctor now (paying the office visit, tests, etc. out of pocket). Obviously they want to seek medical advice as soon as possible, but, they don’t want to ruin any chance of the insurance covering any treatment (such as surgery) that may be needed soon (if a particular diagnosis is rendered).

They have the following concerns.

  1. Since they will be without insurance when the new insurance goes into effect, will they be exempt from any preexisting conditions?
  2. Will HIPAA consider their Temporary Insurance to be credible coverage?
  3. How can they prove credible coverage to their new employer?
  4. Does it matter that they did not enroll in COBRA?

How would you advice the Brown’s? Please address each concern.

 

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