We have health insurance through my spouse's employer. I am also
employed and also have insurance coverage at work available if I
choose to use it.
It is possible, though not too likely, that my spouse have an illness
of the most serious kind.
I would like to know if, when bills start mounting, and the spouse
would start skipping days off work, the employer probably would want
to fire my spouse?
If so, can we transfer to my employer's insurance? Are there normally
"preexisting condition" clauses? (which looks like it is the case).
Would such a switch be detrimental to my own employment?
How long can we maintain cobra coverage, for 18 or 36 months?
In any case, it would appear that hopes of getting a long term illness
covered under employer health insurance are kind of flimsy, no?
That would be a violation of probably both federal and state
You need to get that answered from your employer's insurance
coverage. Probably a talk with your HR dept.
Again, it depends on the health insurance. There is also disability
insurance. Does you or your spouse' employer have a disability
benefits person at the HR dept? That person would be best at
answering these questions.
OP has health coverage through their spouse's employer and has the following
The employer will probably WANT to, but I'm not sure they CAN. I believe it
is against the law to terminate someone who is out on sick leave.
Keep in mind that not getting terminated is not the same as getting a
paycheck. I'm aware of no requirement to continue to pay someone who can't
work. This could mean that you'd have to find a way to pay for the health
insurance coverage, since there'd be no regular check for them to take the
If the employer is covering either the entire premium or some part of the
premium, you can expect that they will stop that if your spouse can't, or
doesn't, return to work within some period of time.
Things like this should spelled out in the employee handbook. Ask HR for
You can always transfer to your employer's insurance, but as you note there
may be issues - some of which you have NOT mentioned:
1 - preexisting condition coverage is generally a matter of state law. For
example, in Maryland an insurer through a company sponsored group plan is
NOT allowed to consider or exclude preexisting conditions and Maryland has
NO MEDICAL underwriting for group plans. In Delaware they ARE allowed to
consider and/or exclude coverage (in part or in whole) and Delaware DOES
HAVE MEDICAL underwriting;
2 - Open Enrollment - some plans only allow enrollment during specific time
periods, usually one or two 30-day windows during the plan year (with
exceptions for new employees who become eligible in the interim), while some
plans allow enrollment at any time during the year;
Not legally, though you may have to pay for part or all of the coverage.
Great question - one that I (nor many others) can answer right definitively
now becuase the new Health Care Reform law is still shaking things out. You
should be eligible for coverage for at least 18 months BUT you may have to
pay for the coverage. The old rules allowed the employer to charge you up
to 105% (I think that's the correct percentage) of the cost of coverage
(with the 5% going to help cover the employer's costs in administering COBRA
coverage). Then we had a change in the law where the employer could get a
credit of up to 65% of the cost of coverage so the employee only had to pay
35%. BUT the window for that credit has closed and I'm not sure how the new
law will impact coverage and costs.
Maybe, maybe not. There are several things you need to consider, many of
which are determined by your employer, the insurance company and the state.
You also have to consider what health insurance is designed to cover.
There are essentially two types of medical issues to address - acute and
chronic. Acute is something that happens while chronic is something that
lasts, is ongoing and usually has collateral issues that need to be
addressed. Most health insurance is designed to cover acute issues - a
broken leg, a car accident, a poke in the eye. It also generally covers
maintenance medication and some maintenance treatment - like medicine for
high blood pressure or diabetes, or the changing of bandages.
What health insurance usually does NOT cover is long term maintenance items
like catheters. It also won't cover any of the collateral issues - for
example, if you become paralyzed it won't cover assistance with Activites of
Daily Livings (ADLs in industry terms) like bathing, dressing, bathroom
help, cooking, etc. For that you need either Long Term Care coverage or
The best recommendation I can make to you is to seek the assistance of a
financial planner, one who addresses ALL the issues and not just one who
does investment work. A comprehensive planner can help you identify and
address issues such as these.
Gene E. Utterback, EA, RFC, ABA
Sorry for your potential problems. You couldn't have picked a more
unsettled time because of the new Gov health policies. Even to
Nothing beats reading the various policies and discussing ALL the
ramifications in detail with both HR Depts. On my retirement we thought
we would stay with my employer's policy. But after comparing, we came
to the absolute opinion that my wife's policy was WAY better in both
coverage and premiums.
My favorite dead horse is Long Term Care Insurance. DON'T! Bad ju-ju.
If you want the security, invest the premium in a deferred annuity and
withdraw when needed for sickness or better for vacations when you find
out it's just a false alarm. LTC Ins only works (ha!) for the former.