Why it helps to know the lingo: COBRA, HIPAA, exclusionary periods and conversion policies

Aside from issues relating to health status, how to get and keep good health insurance is one of the most important health care-related issues for consumers. In an effort to help Missouri residents with what can sometimes be a complicated process; the state and federal government have a host of protections in place.

If your employer provides health care coverage through a group plan, you may be able to retain coverage for a limited period of time after you leave your job. Called COBRA (Consolidated Omnibus Reconciliation ACT) or state continuation coverage, this plan can prove incredibly helpful when you are in-between jobs or awaiting the benefits of your new job’s insurance plan to kick-in and take effect. You will have to pay for this coverage, but there are limits as to what you can be charged.

In the instance you lose your job, another option to explore is HIPAA (Health Insurance Portability and Accountability Act) coverage. Should you meet the plan’s eligibility qualifications you will be guaranteed the right to buy a plan from a Missouri insurance company. When you approach a company, do note, by law, they must offer you a choice of at least two different plans. Another option for those who lose coverage and meet other eligibility qualifications is to purchase an individual plan from the Missouri Health Insurance Pool. On the favorable side, the premium you pay for this coverage is limited, and you will not have to wait through any pre-existing condition exclusionary periods.

Finally, if you lose your group plan, should you be able to meet additional requirements, you may be able to purchase a conversion policy. The benefits of purchasing a conversion policy include: the omission of pre-existing condition exclusionary periods and no capped limit on what you can be charged. However, the benefits may not be as generous as those to which you were accustomed under your old group plan.

If you have low income or modest income, it is possible that you could be eligible for free or subsidized coverage through the Medicaid program. This program offers coverage for pregnant women, families with children, elderly folks and disabled people of low incomes. Missouri’s MC+ for kids offers additional coverage for uninsured children. And, some individuals may be eligible for a federal income tax credit called the Health Coverage Tax Credit (HCTC) which can subsidize up to 65 percent of the cost of a private insurance plan.