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Topic: Question regarding employer health insurance

Forum: Employment, Insurance, and Other Financial Issues —

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Posted on: May 7, 2019 12:14PM

melza89 wrote:

I am currently insured through my husband's employer. Our plan is ok but we consider the options every time there is open enrollment. We can choose from a few different providers & many types of plans. But if we switch plans or providers (but still through the same employer), would the new plan cover my BC treatments/tests?

Dx 5/22/2019, DCIS/IDC, Right, 6cm+, Stage IV, metastasized to bone/liver, Grade 3, ER-/PR-, HER2+ (IHC) Targeted Therapy 5/22/2019 Perjeta (pertuzumab) Targeted Therapy 5/22/2019 Herceptin (trastuzumab) Chemotherapy 5/22/2019 Carboplatin (Paraplatin), Taxotere (docetaxel)
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May 7, 2019 12:39PM vlnrph wrote:

Assuming you are in the US where we still enjoy protection from discrimination due to pre-existing conditions via the Affordable Care Act which has not yet been repealed (although some are trying to destroy it).

Group policies thru employers do not generally use individual underwriting so there is no disclosure of your diagnosis. However, you must beware of self funded plans especially in a small office/firm because those workers who run up big bills are more likely to be easily identified. Then it could be a matter of your husband getting the ax the next time they need to downsize...

In summary, your treatments and tests should have coverage even if you switch plans or providers but it’s a goid idea to carefully examine the options and try to maintain your privacy as much as possible.

IDC too! 🎻💊👪🐩 🇫🇮 🌹🦋 Rt MX+DIEP 4-2011; ALND 5-2011 d/t micromets; TC X 4; tamoxifen; lymphedema 9-2011; switch to letrozole 3-2014 for 1 yr; bone mets 8-2018: Zometa, rads to spine, Faslodex/Versenio Dx 3/7/2011, ILC, 2cm, Stage IIA, Grade 2, 1/25 nodes, ER+/PR+, HER2-
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May 7, 2019 12:45PM kber wrote:

Second vlnrph.  You have legal protections, but check the fine print.

Dx 11/2018, IDC, Left, 5cm, Stage IIB, ER-/PR-, HER2- Chemotherapy 12/7/2018 Adriamycin (doxorubicin), Carboplatin (Paraplatin), Cytoxan (cyclophosphamide), Taxol (paclitaxel) Surgery 5/28/2019 Mastectomy: Left; Prophylactic mastectomy: Right Radiation Therapy 7/17/2019 Whole-breast: Breast, Lymph nodes, Chest wall
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May 7, 2019 12:54PM melza89 wrote:

Thank you vlnrph and kber. Yes, I am in the US and my husband works for a very large employer. I'll make sure to check the fine print when we have the opportunity to switch plans later this year.

Dx 5/22/2019, DCIS/IDC, Right, 6cm+, Stage IV, metastasized to bone/liver, Grade 3, ER-/PR-, HER2+ (IHC) Targeted Therapy 5/22/2019 Perjeta (pertuzumab) Targeted Therapy 5/22/2019 Herceptin (trastuzumab) Chemotherapy 5/22/2019 Carboplatin (Paraplatin), Taxotere (docetaxel)
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Jun 15, 2019 07:51AM TwoHobbies wrote:

Melba, yes you can switch. You just have to have no lapse in coverage. I switched from BCBS to UHC and back to BCBS due to premium costs and had no issues. Both me and my son had expensive pre existing conditions.

Round 1 -bmx, tug flap reconstruction, tamoxifen. Local Recurrence-excision, TCx4, radiation, Zoladex, Anastrazole. Dx 2/22/2011, IDC, 2cm, Stage IIA, Grade 2, 0/7 nodes, ER+/PR+, HER2- Dx 4/25/2013, <1cm, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Jun 15, 2019 10:48AM gb2115 wrote:

Yup if it's an employer provided group plan with no lapse in coverage it should be fine. And if you are switching plans during an open enrollment, your HR will make it seamless. I was switched from one insurance company to another mid-year (we had a June open enrollment), and the new one even upheld my out of pocket met.

Dx IDC in October 2016, stage 2A, 1.2 cm ER/PR+ Her2-, Grade 2, 1/3 nodes. Mammaprint low risk luminal A, Lumpectomy + radiation + tamoxifen. Age 38 at diagnosis.
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Jun 16, 2019 10:50AM Salamandra wrote:

The new plan should cover your treatments in general but it may or may not cover the same doctors and facilities as your old one. So if you like your doctors/hospitals, it's really important to investigate whether they are in network for the new plan, or what kind of out of network coverage the new plan has, and whether that's affordable for you.

(I couldn't tell if this was more of a question about pre-existing conditions or more of a question about variation in coverage).

Can your husband ask around at work to people who are on other plans, and get a sense of which plans people are happy with - especially people dealing with similar health issues? Also, worthwhile to get the full info and paperwork from HR.

Dx at 39. 1.8cm. Oncotype 9. Dx 9/19/2018, IDC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery 10/18/2018 Lumpectomy; Lymph node removal: Sentinel Radiation Therapy 12/3/2018 Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)

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