Catastrophic illness or major medical clauses
Treating and managing most cancers costs a lot of money. Some insurance plans provide for extra coverage under a "catastrophic illness" clause. These are policies that cover major medical care needs. The policies usually have very high deductibles and fairly low premiums. They can be good for people with chronic illnesses. Check to see if your plan includes such coverage.
Health Savings Accounts
If you have or plan to enroll in an insurance plan that has a high deductible, you may want to set up a Health Savings Account (HSA). You don’t have to pay federal income taxes on the contributions you make to the HSA if the money is used to pay for qualified medical expenses. If you use it for anything else, you will be required to pay the tax and a penalty.
Note that an HSA is different from a Flexible Spending Account (FSA); for instance, you can have an FSA even if you don’t have a high deductible health plan. FSA funds are set up to be used for both medical and child care expenses. But the FSA money you don’t use goes away at the end of each year, while the HSA money is yours until you take it out. For more information about setting up an HSA you can contact your employer, bank, or credit union.
Pre-existing condition exclusions
A pre-existing condition is a health problem that you had before you joined your medical plan. If you are a cancer patient and join a new health insurance plan, you may face a pre-existing condition exclusion period. A pre-existing condition exclusion period means your plan will make you wait before they pay the costs of the pre-existing medical problem. The wait may be as long as a year for insurance you get through an employer.
If you refuse health insurance when it is first offered and then sign up later, the pre-existing condition exclusion can climb to 18 months after you sign up. And the time can be longer for independent policies and those not through an employer. In fact, some insurance may not cover certain illnesses at all.
If you get health insurance through your job, Federal law prevents the employer from imposing an exclusion period for a pre-existing condition in some situations. For instance, you may be able to avoid the exclusion period if you have had health insurance with a previous employer and have not been without health insurance coverage for more than 63 days. Some states require an employer-based insurance company to cover your pre-existing condition even if you were without insurance for a bit more than 63 days. You can call the US Department of Labor at 1-866-444-3272 to find out more about your specific situation. (See the section, "The Health Insurance Portability and Accountability Act of 1996" for more information.)
But if you are joining a plan that is not group coverage (including some high risk pools), the pre-existing condition exclusion period can be many years or even unlimited. If you are getting a plan through someone other than an employer, the insurance provider can impose an elimination rider that would keep that disease, body part, or body system from ever being covered by that policy. It's important to know these things before you sign up.
It's also important to know that the Affordable Care Act (ACA) passed in 2010 affects pre-existing condition exclusion periods, among many other aspects of health insurance. The ACA does not allow insurance companies to deny coverage for pre-existing conditions (such as diabetes or cancer) in children as of September 2010 and in adults starting in 2014. See the section called "The federal law that is changing health insurance: The Affordable Care Act of 2010" for more on this.
National law prohibits discrimination based on genetic testing or test results
The Genetic Information Nondiscrimination Act (GINA) does not allow health insurers to turn down individuals or charge higher premiums for health insurance based on genetic information or the use of genetic services, such as genetic counseling. GINA defines genetic information as any of these:
- A person's own genetic tests
- The genetic tests of family members
- One or more family members with a genetic disease or disorder
GINA bars group health plans, individual plans, and Medicare supplemental plans from using genetic information to limit enrollment or to change premiums. It also forbids these insurers to request or require genetic tests. GINA applies to all health insurance plans (including federally regulated plans, state-regulated plans, and private individual plans).
The law also forbids discrimination by employers based on genetic test results or genetic information. GINA states that employers must not discriminate on the basis of genetic information (no matter how they got the information) in hiring, firing, layoffs, pay, or other personnel actions such as promotions, classifications or assignments.
Look carefully at health insurance options at work
Look closely and compare plans if you are trying to decide among several insurance or managed care options. Sometimes there is a chance to look at and consider different types of coverage during open enrollment periods. (Open enrollment is the time period when you are able to make changes in your coverage. It usually happens once a year). Sometimes it is possible to add yourself, your spouse, or a child to a work health insurance policy outside the open enrollment period if you've had a major change in situation; for instance, if you've gotten married or your spouse has been laid off. Check with your health insurance administrator at work about this.
Hospital indemnity policies
Hospital indemnity policies, sometimes called supplemental medical policies, pay a fixed amount for each day a person is hospitalized. There may be a limit on the total number of hospital inpatient days it will pay for in a calendar year, or a cap on the total number of days it will pay. The money received from this type of policy can be used as the insured wishes. It is often used for medical costs not paid by the insurance company, or the other expenses that families face when one member is ill.
Case managers and financial assistance planners
Hospitals, clinics, and doctors' offices often have someone who can help you fill out claims for insurance coverage or reimbursement. A case manager or a financial assistance planner may be able to help guide you through what can be a complicated process.
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