If I opt for ind. provider of healthcare ins. rather than employee plan, will they have to pick up my wife?

Question

I need her covered, but she is the one who doesn't do so hot in getting accepted. And my Employer's plan is outrageous; $124/mo. for me, $682 for me + spouse. Sounds like it must be a mistake. It's not.

I'd go with them if it was the only way to insure her. But I'm thinking, and was told by one agent already, that once I am on their plan they have to pick her up as an employee plan would.

Agreed???

Answer 1

No - an individual plan does not have to take your spouse just because they approve you.  Your wife would still have to go through medical underwriting.

Group rules are different than individual plan rules.  Your employer would have to take your eligible spouse, if you enrolled for coverage.  An individual plan has no such obligation - everyone on the policy has to pass through underwriting.

Answer 2

Once you are on the group plan they have to pick your wife up.

If you are talking about an individual plan, she will have to pass underwriting. Depending on her medical conditions she may be approved. The problem you are going to have is getting her approved fast enough so you don't miss your open enrollment window.

If you open enrollment has already passed you can't just drop out of the group plan unless you have a qualifying event.

I would talk to a broker that offers many different insurance companies. They can take her medical conditions into account and find the best company to apply with.

Answer 3

as everyone else has said, anything that is "individual" based does NOT have to accept your wife, as she would have to go through underwriting.

with a group policy, any eligible dependents can be added. now, if you have a PPO, you may have a waiting period for pre-existing conditions (since it sounds like she wouldnt pass through individual underwriting, it sounds like she has a condition of some kind, so this is important to understand). most waiting periods on PPO's are six months. so, nothing that is preexisting would be covered for six months.

if you have an HMO, there are generally no waiting periods.

now, to comment on one of the broker's answers.. yes, you can cancel off your plan any time. check your Evidence of Coverage (benefit booklet) for the "Right of Cancellation" clause. you can cancel whenever.. but, you cannot ADD whenever. that is when a qualifying event would come into play.

Answer 4

No, an individual policy is NOT obligated to pick up your spouse.  If she's "not so hot" in getting accepted, the ONLY option is going to be your employer's plan.

Answer 5

No - she will have to qualify and her premium will be determined through the underwriting process.