Diabetic Canadian Fiance Currently on Disability

[MelissaAndJordan 5]

Hi All! I have been pondering over several issues as it relates to some financial and health issues.

My Canadian Fiance has type 1 diabetes. Because of some severe anxiety issues stemming from that, he has been on Canadian disability for about two years. He is in great shape aside from diabetes, the anxiety just became overwhelming for him. That said, since we have been together (1 1/2 years) he has advanced tremendously in coping with it and I have started my own business, in part so that he will have a workplace (home) where he can feel comfortable.

Here are my questions:

1) We just received our NOA2. I am concerned that even though I currently make enough money and, just to be certain, we have a co-sponsor who makes even more, that if he goes to his interview and he is currently on disability, even if he has no need or intention of ever being on it here in the United States, that they will be concerned about him becoming a public burden (or however you word it) and we will get denied. We are (I am) at a financial point where we CAN take him off disability right now, but is it absolutely necessary that we do? We keep going back and forth because we know the costs that are coming between finishing this process, moving, wedding, starting a life together etc etc

2) As I mentioned, I work for myself. I have private health insurance. Anyone have any idea how much more we can expect to pay once I put him on my policy?

3) If there are any other type 1 diabetics, what supplies did your provider cover? I have been able to price out the insulin through my plan, but can not find any info on other things he uses (infusion sets, reservoirs and test strips) and the thought of calling the insurance company makes me ill lol

Thanks Everyone!

[Colleens 40]

He should have no issues with being on disability when moving to the US.

As for adding him onto your insurance you will have to call your company to find out what it will cost. I know that some companies will not cover a pre-existing condition. But since he is coming from a country that has a national health plan he is covered by the HIPPA laws. So based on that he can not be refused.

I was in a similar situation when I moved to the US (I had a pre-existing condition....pregnancy!!!) and I found a company that would cover me, but for individual insurance for me only with the maternity rider, it was going to cost me $2450.00 a month!!! I hope that yours is nothing like that!!

Good luck.

[MelissaAndJordan 5]

He should have no issues with being on disability when moving to the US.

As for adding him onto your insurance you will have to call your company to find out what it will cost. I know that some companies will not cover a pre-existing condition. But since he is coming from a country that has a national health plan he is covered by the HIPPA laws. So based on that he can not be refused.

I was in a similar situation when I moved to the US (I had a pre-existing condition....pregnancy!!!) and I found a company that would cover me, but for individual insurance for me only with the maternity rider, it was going to cost me $2450.00 a month!!! I hope that yours is nothing like that!!

Good luck.

Eek! Yeah just for myself, with no medical issues I pay $200/mo, so I just have a nightmare scenario playing around in my head for once I add him on. I've already double checked about the pre-existing condition. What is ironic is that because I hadn't had insurance for a while, I have to wait a year for any preexisting conditions to be covered, yet he will be covered immediately Luckily, if nothing else, he's not pregnant

Thanks for the reassurance about the disability!

[M&Pooh 12]

Eek! Yeah just for myself, with no medical issues I pay $200/mo, so I just have a nightmare scenario playing around in my head for once I add him on. I've already double checked about the pre-existing condition. What is ironic is that because I hadn't had insurance for a while, I have to wait a year for any preexisting conditions to be covered, yet he will be covered immediately Luckily, if nothing else, he's not pregnant

When you're saying you have "private" insurance, do you mean individual or group policy? If former, please tell us the name of such a generous insurance company who would cover a diabetic spouse? Did you tell them he had diabetes and they gave you a quote?? Many insurers just won't issue the policy to a person with diabetes - 'deemed uninsurable".

As to the covering supplies - you need to carefully check your policy "Exclusion & limitation" section, as well as "DME annual limits" ( pump supplies might be treated either as DME, or as regular drugs; insulin almost always is treated like a usual brand name drug ), Also, it's necessary to know what state you are from - some states mandate certain level of coverage for diabetics.

I sincerely feel for you guys. Hopefully, you know what you're doing...

[M&Pooh 12]

But since he is coming from a country that has a national health plan he is covered by the HIPPA laws.

That's an interesting statement. I would greatly appreciate if you can provide a link to the provision in the HIPPA that gives such a protection to the immigrants from the countries with socialized healthcare. Seriously, it would be of big help.

[david'sgirl 134]

That's an interesting statement. I would greatly appreciate if you can provide a link to the provision in the HIPPA that gives such a protection to the immigrants from the countries with socialized healthcare. Seriously, it would be of big help.

I sent a letter to Blue Cross/Blue shield stating my husband is a UK citizen and has had NHS his entire life so there should be no issue with proving he has had credible coverage and is therfore not subject to pre ex. They responded stating that in anticipation of a federal mandate they no longer have pre ex for any members. A lot of insurers are mirroring "Obama care". for ex my daughter is 23 and we just found out she can remain in her father's plan until she is 26 in anticipation of the new legislation.

I am assuming he is on a pump? If you get it through a specialty pharmacy vendor it will be less. If you can give me the specifics (model #, number of each supply, your insurance co, PPO network, pharmacy and state I can get pretty accurate estimate)

btw I am a nurse (since 83)and have been working for an insurance company dealing with ERISA/self funded plans for over 10 yrs- feel free to PM me.

[M&Pooh 12]

Thanks a lot, david'sgirl! That's very helpful to know!

This is what I am trying to understand - is it really REQUIRED from insurers to cover such immigrants ( by HIPPA or any other legislation ) or is it case-by-case and a goodwill of a particular insurance company?..

We recently had not-so-good experience with BCBS insuring my stepson. We were honest and stupid by disclosing his minor toe fracture happened a couple of months prior and completely healed by the moment we applied. As a result, the premium jumped about 150% ( i.e. 2.5 times ) I pressed the agent really hard demanding to explain to me how a completely healed trauma ( not ongoing chronic condition ) can cause such a jump and his reply was - "this is according to the actuary company BCBS is using... ask them".

for ex my daughter is 23 and we just found out she can remain in her father's plan until she is 26 in anticipation of the new legislation.

For the record - this is not "in anticipation", this provision has been in effect since Sept. '10 ( unless the insurer had a special waiver )

I am assuming he is on a pump? If you get it through a specialty pharmacy vendor it will be less. If you can give me the specifics (model #, number of each supply, your insurance co, PPO network, pharmacy and state I can get pretty accurate estimate)

btw I am a nurse (since 83)and have been working for an insurance company dealing with ERISA/self funded plans for over 10 yrs- feel free to PM me.

Please share your findings... it would be helpful for other people as well, not just for the OP... thanks!

[M&Pooh 12]

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Edited January 20, 2012 by M&Pooh

[Kathryn41 3,205]

I am type 1 diabetic as well. Having diabetes was no problem in getting my visa. When I got here and was added to my husbands existing insurance (Cigna at the time) they required a letter stating I had received health insurance coverage up to the time immediately prior to being added to my husband's policy or any diabetic expenses I had would not be covered for one year. I had OHIP plus additional insurance that covered prescriptions, dental, vision and such through my employer in Canada. I was actually fortunate because I had enough overtime and holiday time saved up that I was still 'on the payroll' for another month when I moved here, and my health insurance continued for 30 days after my last 'official' day of employment so there was actually an overlap of coverage for me. I obtained a letter verifying my insurance coverage dates from Sun Life and printed out the information about OHIP and submitted that. I was covered immediately and the premium was the same as for adding a family member who wasn't diabetic. When his employer switched plans to BlueCross Blue Shield, Cigna automatically provided me with a letter verifying coverage and I submitted that with my first claim.

So, if there will be a time between when your fiance leaves Canada and his provincial coverage and the time you are able to enroll him on your plan, you might want to investigate purchasing short term 'bridging' health insurance for him so that he is never without some sort of coverage. That will pretty well ensure that your insurance company won't be able to deny him coverage for the one year pre-existing condition clause. He will just need to be able to prove he was covered.

Depending on your plan, you can expect your premium to increase but you will also face additional expenses even with coverage. Diabetes is not a cheap condition and is more expensive in the US than in Canada. (My copays for some of my supplies is virtually the same as the cost of the whole item was back in Canada before reimbursement). He will have deductibles to meet, co-pays and non-covered costs related to his diabetic supplies to cover. These vary between plans so you really do need to talk to your provider - no one else is able to tell you what to expect.

Most insurance companies also have their 'preferred providers/suppliers' which may not be the ones that the doctor wants him to use, which means that he may have higher co-pays for certain medication and supplies. I am not on a pump so have two different types of insulin, one of which is not their preferred insulin - however, it is the one that works -( not all insulins works the same as there are variations in time of action from very quick to very slow.). My test strips are also not the ones my insurance company primarily supports so I pay more for those, however, my glucometer is the best brand on the market and the one my endocrinologist (and I) want me to use due to accuracy and ability to track blood glucose records. The one the insurance company supports is not as accurate or as good and is better suited for those with type 2 who are not doing constant multiple times a day monitoring.

So, you do need to check with your insurance company about what they cover, how much of it they cover, and what their 'preferences' are with regards to brands. Your fiance will also be under the care of an endocrinologist (or should be) and will need, at the very least, quarterly appointments. The co-pay for specialists is usually higher than for regular doctors, and he will have tests done quarterly as well that will have a copay involved (monitoring long term glucose control, metabolic profiles, kidney function, etc.). Some may be covered 100% but most are not so there is the extra costs there as well. He will also need a yearly eye exam..

Most of diabetes is preventative care. Under control it really is not a hardship or a hindrance in life and someone with diabetes can do virtually everything a non-diabetic can do. The bigger problems occur when diabetes isn't controlled and can lead to some very serious complications that can include heart attacks, blindness, amputation and various neuropathies, and even death. While being on a pump is more expensive in terms of supplies, it is also the best way to keep diabetes under control.

Good luck.

Edited January 20, 2012 by Kathryn41

[Kathryn41 3,205]

That's an interesting statement. I would greatly appreciate if you can provide a link to the provision in the HIPPA that gives such a protection to the immigrants from the countries with socialized healthcare. Seriously, it would be of big help.

I don't have the link, however, individuals coming from countries with national health coverage are considered insured for health care costs. It appears that if you have existing insurance prior to being enrolled in a policy in the US, then they can't exempt you from covering pre-existinng conditions. If you have a lapse in coverage, then you can be excluded, at least for now. Once the full extent of the new health care law comes into effect, they won't be able to deny you coverage although they may make the premiums exorbitant. So, be prepared to provide proof of coverage either with an official letter or, as I did with OHIP - which covered hospitalization and doctors visits - a statement from on line showing what is and isn't covered and who it covers. As long as there is no 'interruption' in coverage, pre-existing conditions can't be exempted.

[M&Pooh 12]

I don't have the link, however, individuals coming from countries with national health coverage are considered insured for health care costs. It appears that if you have existing insurance prior to being enrolled in a policy in the US, then they can't exempt you from covering pre-existinng conditions.

This is what I am trying to find a proof for. I can hardly believe HIPPA explicitly states this about non-US health insurances but would be glad to have somebody prove I am wrong.

Once the full extent of the new health care law comes into effect, they won't be able to deny you coverage although they may make the premiums exorbitant.

Sorry, Kathryn, this is just plain incorrect. The whole idea of this clause in PPACA is that the insurers issuing individual policies to a person with chronic condition WILL BE PROHIBITED from charging higher prices. It will work the same way as nowadays works with the group insurance where the premium doesn't depend on your health condition...

Of course, this will hold true if our Republican folks won't be able to kill the law one way or another...

[Kathryn41 3,205]

This is what I am trying to find a proof for. I can hardly believe HIPPA explicitly states this about non-US health insurances but would be glad to have somebody prove I am wrong.

Sorry, Kathryn, this is just plain incorrect. The whole idea of this clause in PPACA is that the insurers issuing individual policies to a person with chronic condition WILL BE PROHIBITED from charging higher prices. It will work the same way as nowadays works with the group insurance where the premium doesn't depend on your health condition...

Of course, this will hold true if our Republican folks won't be able to kill the law one way or another...

Well, that is good to know. My information is based upon reading current situations where individuals are not being denied right now, but are being quoted huge prices for the premiums. When is this clause to be fully implemented? I know it was a phased in process and I don't recall if this one is to be in place by 2012 or 2014.

I only have my own past experience for 'proof' of the first. When I submitted my first claim and it was denied due to a pre-existing condition, I contacted the insurance company and talked to them on the phone. They basically said that unless I could prove that my medical condition was covered by insurance immediately prior to enrolling with them and that there was no lapse in insurance or time I had not been insured, then any costs related to my diabetes would not be eligible for coverage for one year. I said I was covered and had been covered and they said to send in proof of that coverage, including the start and end dates of the coverage and they would review it. That is what I did - OHIP covered hospital and doctor care while my health coverage through my employer covered everything else. I provided them with proof of both and they then covered me for my diabetes as well.

[Boiler 45,993]

They may be required to provide coverage, surely the issue is whether you can afford the premiums?

[MelissaAndJordan 5]

When you're saying you have "private" insurance, do you mean individual or group policy? If former, please tell us the name of such a generous insurance company who would cover a diabetic spouse? Did you tell them he had diabetes and they gave you a quote?? Many insurers just won't issue the policy to a person with diabetes - 'deemed uninsurable".

As to the covering supplies - you need to carefully check your policy "Exclusion & limitation" section, as well as "DME annual limits" ( pump supplies might be treated either as DME, or as regular drugs; insulin almost always is treated like a usual brand name drug ), Also, it's necessary to know what state you are from - some states mandate certain level of coverage for diabetics.

I sincerely feel for you guys. Hopefully, you know what you're doing...

http://www.diabetes.org/living-with-diabetes/treatment-and-care/health-insurance-options/health-insurance-in-your-state/virginia.html

In Virginia, Blue Cross Blue Shield has been identified as the insurer that must provide coverage to all residents who apply, regardless of any health conditions that they may have. This is called guaranteed issue. Residents can purchase an individual health insurance policy from Blue Cross Blue Shield, but unfortunately, you may be required to pay a higher premium because of your diabetes (or another health condition).

[MelissaAndJordan 5]

That's an interesting statement. I would greatly appreciate if you can provide a link to the provision in the HIPPA that gives such a protection to the immigrants from the countries with socialized healthcare. Seriously, it would be of big help.

From my particular insurance company:

Coverage for the pre-existing condition is usually provided after a 12-month waiting period. However, this 12-month period will be reduced by any period during which the member was covered under “creditable coverage” unless there has been a break in coverage of at least 63 days. Creditable coverage includes group health plan coverage, individual health insurance, Medicare, and certain other types of coverage.