Health insurance only for citizens?

[Ivy. 113]

I doubt becoming an LPR is a qualifying event. Marriage is.

US Government says it is. I have been married to a US citizen since 2012, but not having legal status in the US (except as a tourist occasionally), I was not qualified for health insurance. Now that I am a resident, I am.

Okay, for one thing: The HR is either uneducated or lying to you.

I wish I could advise more in this situation but even the federal mandate spells out very clearly that LPR not only grants you the ability to obtain health insurance but marriage and a change in immigration status is a qualifying event for special enrolment.

Secondly: I suspect you could have a fabulous little suit case on your hands if they continue with this behavior.

Thirdly: If you don't want to deal with putting on heavy motivation for them to comply your other option would be to go to the federal exchange, as Texas does not have a state exchange, and purchase insurance through there.

If they would like to kick this back as Humana's fault they need a little education: Even the Humana website discusses that you should provide your SSN and relevant immigration numbers/documents to be able to enroll. You are an LPR with legal status in this country, you are not illegal or even under DACA (which restricts ability to obtain insurance while on hold) - there is no reason to be denied coverage.

Now if what they are actually trying to do is a ''spousal carve out'', by implying (if you are working somewhere) that they have the right to deny you based on your ability to get coverage through your own employer that would be an entirely different matter.

yuna, this is EXACTLY what I am thinking. Exactly.

I have stayed in the US for 5 months on my tourist visa from Sept 2014 - Feb 2015. I left, did my immigrant interview in Croatia and came back March 17th. I got my SNN in mail end of March. I have been trying to deal with this since. I am not currently employed anywhere and do not have health insurance.

Soooo, what I did now, other than have my husband talk to them via phone, I had us logged into their system, I triggered the change in his health insurace, entered all the information and now we await official reply. He will be going to work with my passport with my visa and my SSN and we will see what happens. At least this should leave some paper trail.

Edited April 12, 2015 by Ivy.

[NikLR 13,227]

If the US government (aka health insurance for federal employees) says that it's a life event, then I cannot see how any other health care can say otherwise? That's just odd.

[j&ana 363]

US Government says it is. I have been married to a US citizen since 2012, but not having legal status in the US (except as a tourist occasionally), I was not qualified for health insurance. Now that I am a resident, I am.

yuna, this is EXACTLY what I am thinking. Exactly.

I have stayed in the US for 5 months on my tourist visa from Sept 2014 - Feb 2015. I left, did my immigrant interview in Croatia and came back March 17th. I got my SNN in mail end of March. I have been trying to deal with this since. I am not currently employed anywhere and do not have health insurance.

Soooo, what I did now, other than have my husband talk to them via phone, I had us logged into their system, I triggered the change in his health insurace, entered all the information and now we await official reply. He will be going to work with my passport with my visa and my SSN and we will see what happens. At least this should leave some paper trail.

the insurance company can not discriminate against her for being LPR and she is qualify. However there is no law stating that her husband company has to provide insurance for her. they can pay for any part of insurance they choose and decide what part of insurance coverage they choose to pay for . So there is no lawsuit

As other have mention it is best to call the insurance company

[yuna628 9,671]

The very reason why the company is saying the insurance company is refusing to provide insurance, is the very reason why she could have legal claim. It does not appear that they are doing a ''spousal carve out'', because the company has expressly stated they will not provide insurance unless she is a ''citizen'' -- this is contrary to federal law. Insurance companies must be federally compliant. If there are other spouses added to policies within the company, but you are not this would certainly be discriminatory. They aren't denying based on being a spouse, they are denying based on being an LPR. They are allowed to either refuse coverage to all spouses within the company or not at all. No picking and choosing to exclude one person. They aren't federally obligated to provide coverage to spouses no. But if they provide coverage to other spouses and exclude one based on a reason that is contrary to federal law -- that company has a problem.

You could call Humana and try and get further clarification on this. You may or may not get the runaround. Sounds like you have already. I feel for you OP.

Edited April 12, 2015 by yuna628

[NikLR 13,227]

https://www.humana.com/insurance-through-employer/enrollment-center/life-changing-events

She should be able to be added because moving to the USA makes her lose her other health care.

I also cannot find on their website that they only accept USCs, so the HR dept is lying.

[Ivy. 113]

The very reason why the company is saying the insurance company is refusing to provide insurance, is the very reason why she could have legal claim. It does not appear that they are doing a ''spousal carve out'', because the company has expressly stated they will not provide insurance unless she is a ''citizen'' -- this is contrary to federal law. Insurance companies must be federally compliant. If there are other spouses added to policies within the company, but you are not this would certainly be discriminatory. They aren't denying based on being a spouse, they are denying based on being an LPR. They are allowed to either refuse coverage to all spouses within the company or not at all. No picking and choosing to exclude one person. They aren't federally obligated to provide coverage to spouses no. But if they provide coverage to other spouses and exclude one based on a reason that is contrary to federal law -- that company has a problem.

You could call Humana and try and get further clarification on this. You may or may not get the runaround. Sounds like you have already. I feel for you OP.

Could you provide me with a link? Everything you are saying makes sense to me (child of layers and a failed law student in my own country, lol), but I am not familiar with US law so I do not know where to look for the specific link/law/article.

Soooo, we prompted adding me to my husband's insurance ourselves. Now HR wants proof I lost my other insurance. Other than my immigrant visa, I have none. We sent them a scan of my visa. They also asked for a copy of our marriage certificate, we sent that, too. Now we shall see what happens.

Once again, thanks everybody. I apreciate this.

[Ivy. 113]

GAH!!! They say this:

Sorry, but I needed to check on this due to your spouse not losing current coverage and her situation with just gaining permanent residency. Unfortunately, this does not qualify her to now join the plan here. We have spoken with our representative at Humana and they have confirmed this is not a qualifying event.

You may want to look at www.healthcare.gov. This is the federal marketplace exchange for medical coverage. Their open enrollment ended on 2/15/15, however they are currently having a special enrollment for people who have not yet gained coverage in 2015. The deadline for this special enrollment period is 4/30/2015.

[yuna628 9,671]

Could you provide me with a link? Everything you are saying makes sense to me (child of layers and a failed law student in my own country, lol), but I am not familiar with US law so I do not know where to look for the specific link/law/article.

Soooo, we prompted adding me to my husband's insurance ourselves. Now HR wants proof I lost my other insurance. Other than my immigrant visa, I have none. We sent them a scan of my visa. They also asked for a copy of our marriage certificate, we sent that, too. Now we shall see what happens.

Once again, thanks everybody. I apreciate this.

Well all insurances must be compliant with the Affordable Care Act. There's tons of provisions the company must abide by. Some older plans had to be restructured, chucked out, or 'grandfathered' in like my own, using certain exemptions. That's where you had people saying ''hey I lost my coverage, when the President said I could keep it!" or ''hey my insurance premium for my old plan tripled!" A grandfathered plan in theory could get around a few things in the law if it were purchased prior to March 23rd 2010. These are typically more expensive for the employer or purchaser to have, so many moved onto the newer ACA compliant plans to avoid being smacked with fees for not being compliant.

Now, if they were trying to claim this then here is the part of the law mentioning grandfathering job-based plans.

Job-based grandfathered plans can enroll people after March 23, 2010 and still maintain their grandfathered status. They can do this as long as the plans haven’t been changed in ways that substantially cut benefits or increase costs for consumers, notify consumers with these policies that they have a grandfathered plan, and have continuously covered at least one person since March 23, 2010.

https://www.healthcare.gov/health-care-law-protections/grandfathered-plans/

I don't think of course that is what HR or even Humana (if they really are the culprit) is saying is what applies in this case. Even pre-ACA I can't think of any insurance polices that refused to cover an LPR. It would be unthinkable for an LPR or even a student to not be eligible in the same way a citizen would.

Here's the federal website that explains immigration coverage.

https://www.healthcare.gov/immigrants/immigration-status/

Regardless of if it is the federal exchange or state exchanges, legal immigrant status is covered. Even explained here http://www.nilc.org/immigrantshcr.html

In case you are forced to give up and want to go over to the federal exchange (I bet you there's some Humana plans over there being offered ironically). Here's where it talks about qualifying life events and special enrolment periods, which LPR is certainly covered, as is losing old coverage, and marriage.

https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/

https://www.healthcare.gov/sep-list/ Misconduct by a non-marketplace assister that prevented you from obtaining insurance would be one of those complex qualifying events too.

Here is also further explanation on spousal carve outs, which I don't think applies either. http://www.psfinc.com/press/spousal-carve-outs-and-surcharges

Since you are saying the HR seems willing to change their mind if you can prove you lost old coverage is baffling to me. Here they are clearly trying to use one of those 'special qualifiers', instead of the most obvious one that actually applies! Hope you can get out of this run-around. Sounds like you may be getting somewhere... sort of.

Edited April 13, 2015 by yuna628

[NikLR 13,227]

GAH!!! They say this:

According to the link I provided the should not be saying this. If your spouse had health care in their other country, they could not keep it when moving to the USA, that qualifies them as a life changing event. I'm not sure how health care works in Croatia however. I know in Canada it is provincially available and you only purchase more in-depth coverage if you choose. When you become a permanent resident of the USA you are no longer a resident of that other country.

Now my husband's work ALSO said the same thing, however I think they were wrong and just did not look at the complete picture. It may require some proof to show that become an LPR is in fact enough of a life changing event because you lose all other health coverage that you had from your other country.

[Ivy. 113]

They say gaining permanent residence is not a qualifying event.

Losing coverage, is, though. They want proof that I lost coverage. I can not provide what I do not have:

I had health insurance in Croatia. I no longer live in Croatia.

I never had health insurance in the US. My Croatian health insurance does not extend to the US.

When traveling here, I was buying tourist health insurance before. Since I am no longer traveling, that option is also out.

I don't have any kind of paperwork I could give them that says I lost coverage. Urgh.

Yes, I can buy Humana on the marketplace. You can bet your ### I won't.

Edited April 14, 2015 by Ivy.

[milimelo 4,477]

Why can't you have a family member in Croatia go to Zavod za zdravstveno osiguranje (HZZO?) and have them type up a letter that as of x date you're no longer covered with health insurance in Croatia? If you can sign up for insurance in Croatia you should be able to de-register as well, no?

I know when we were switching from tricare to my employer's insurance no proof was required even though we did receive a letter saying we had tricare coverage from-to.

[Boiler 45,467]

Oe talk to somebody who has a clue?

[Dakine10 5,452]

They say gaining permanent residence is not a qualifying event.

Losing coverage, is, though. They want proof that I lost coverage. I can not provide what I do not have:

I had health insurance in Croatia. I no longer live in Croatia.

I never had health insurance in the US. My Croatian health insurance does not extend to the US.

When traveling here, I was buying tourist health insurance before. Since I am no longer traveling, that option is also out.

I don't have any kind of paperwork I could give them that says I lost coverage. Urgh.

Yes, I can buy Humana on the marketplace. You can bet your ### I won't.

The ACA (Obamacare) recognizes becoming a citizen or LPR as a special event and you qualify for enrollment under that. Employers are moving towards ACA guidelines but are not there yet, especially smaller employers. They can't deny based on citizenship, however they may only recognize the marriage as the qualifying event in which case you must be added usually within 30 or 60 days of marriage, depending on the employer.

That said, I agree with what many have posted - HR's often screw this up because it's outside of what they usually deal with. Whenever they start giving different reasons each time you call, it's worth pushing the issue. However you may end up having to get ACA coverage until the next open enrollment.

[NikLR 13,227]

Its okay.. humana is one of the lower rated health providers.

We'll be picking a new provider next year as well. We have GEHA which is federal, so in our state it's United.

[Morningmist 76]

XENOPHOBIA...I've met HR reps like that. Seriously, I feel like failed personnels land in HR. I do feel like depending on how high up the pecking order this HR rep is, you should go higher. Nothing gets people to punch someone like talking to HR in our company. They make up stuff all the time.