Getting or Keeping Health Insurance After Diagnosis

Losing health insurance coverage during a serious illness such as breast cancer is a personal disaster that can be hard for a breast cancer patient to avoid. Usually an existing health insurance policy cannot be changed or canceled due to diagnosis or treatment of breast cancer. The exceptions would be when the premium has not been paid, or the insurance was obtained through fraud, or the change in the policy applies to all people insured under the policy, not just those diagnosed with breast cancer. Susan Berke Fogel and Paula D. Pearlman, California Women's Law Center, Surviving the Legal Challenges: A Resource Guide for Women with Breast Cancer 36, 1998. However, breast cancer may lead to job loss or divorce, situations that can result in loss of insurance coverage.

The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) provides a way to retain health insurance, even after job loss or divorce from a spouse who was the covered employee. 29 U.S.C. §1161 et seq. Under COBRA, a recipient of group health insurance benefits who experiences a "qualifying event" is entitled to up to 18, and sometimes 36, months of continued coverage under the group plan. Qualifying events are: 1) when the covered employee reduces her work hours and thus loses her right to have her employer pay the premiums; 2) when the covered employee leaves her job for any reason other than being fired for gross misconduct; 3) when the covered employee dies (if there are dependents who can, and wish to, pursue a claim; 4) when a covered spouse becomes divorced or legally seperated from an employee (note there may be exceptions for court ordered coverage); 5) when the covered employee becomes eligible for Social Security and Medicare; or 6) when the employer files for bankruptcy. Susan Berke Fogel and Paula D. Pearlman, California Women's Law Center, Surviving the Legal Challenges: A Resource Guide for Women with Breast Cancer 43, 1998. If, within the first 60 days of COBRA coverage, the patient is determined to be disabled under the Social Security Administration's standards, then the patient is entitled to an additional 11 months of coverage for a total of 29 months.

It is important for a breast cancer patient to maintain continuous health insurance coverage so that she will not have to wait for treatment if her insurance status changes. The dramatic decrease in survival rates of breast cancer patients, when treatment is not started before the cancer has metastasized, underlines the crucial importance of timely treatment. Many insurance policies have an exclusionary period for the newly insured that excludes expenses for treatment of a preexisting condition for a specified time, which can be as long as 18 months. L. Susan S. Slavin, Esq. Cancer Advocacy Project, New York, Outline of Speech Before the Association of the Bar of the City of New York, Mar. 3, 1999. Under The Health Insurance Portability and Accountability Act of 1996 (HIPAA), the exclusionary period can be reduced or eliminated (depending on the time during which the person had previous coverage), if there was not a break in insurance coverage of 63 days or more. 29 U.S.C. §1181, 1182. A "preexisting condition" is a condition for which medical advice, diagnosis, care, or treatment was recommended or received during the 6 months prior to the start of the insurance. Id.

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