Hi orbitphreak,
As you know, health insurance is a rather complicated business and
trying to sort it all out in a forum such as this is next to
impossible because there are so many variables that need to be
addressed (many of a personal nature). That said, I think I can lead
you in the right direction. If your mother still has the letters of
denial from Kaiser, Blue Cross, and Blue Shield, she may be eligible
for California MRMIB.
Keeping Group Coverage/Getting Individual Coverage
"California Major Risk Medical Insurance Program
(www.mrmib.ca.gov/MRMIB/MRMIP.html) helps to provide health insurance
for Californians who are unable to obtain coverage in the open market.
Californians qualifying for the program pay part of the cost of their
coverage, with the State of California paying the rest. For an
application, call toll-free 1 800-289-6574."
http://www.healthinsurancefinders.com/HealthInsuranceDir.aspx?st=CA&prodId=200
Please click on the following link for full instructions.
California Major Risk Medical Insurance (MRMIB)
"The California Major Risk Medical Insurance Program (MRMIP) is a 36
month program developed to provide health insurance for Californians
who are unable to obtain coverage in the individual insurance market.
The MRMIP is administered After 36 consecutive months of enrollment in
MRMIP, individuals will be disenrolled and offered guaranteed coverage
in the individual insurance market."
Eligibility
In order to be eligible for the MRMIP:
1. You must be a resident of the state of California...
2. You cannot be eligible for both Part A and Part B of Medicare...
3. You cannot be eligible to purchase any health insurance for
continuation of benefits under COBRA or CalCOBRA...
4. You must be unable to secur adequate coverage. This can be
demonstrated in any of three ways:
? If you have been denied individual coverage within the previous 12
months. A letter/copy of a letter from a health insurance carrier,
health plan or health maintenance organization denying individual
coverage within the last 12 months must be submitted with your
complete application...
http://www.mrmib.ca.gov/MRMIB/MRMIPBRO.pdf
In regards to COBRA, the law changed in 2003 and perhaps your mother
was injured before The Cobra Coverage Act of 2003 was enacted. At any
rate, if she had been eligible for a continuation of coverage (by
either COBRA or Cal-COBRA), she should've been notified.
You may enroll in Cal-COBRA if you are either one of the following and
meet certain criteria:
1. An employee of an employer with more than 20 employees (or a
dependent of such an employee) and you are continuing coverage after
exhausting federal COBRA coverage. or
2. An employee of a small employer (2-19 employees) (or a dependent
of such an employee) and have a "qualifying event."
"If you are covered under federal COBRA (remember federal COBRA
applies to employers who have 20 or more employees), you exhaust
federal COBRA and you had less than 36 months of COBRA coverage, you
may have the opportunity to continue coverage for up to a total of 36
months through a combination of COBRA and Cal-COBRA.
You should receive notification of the coverage available prior to the
end of your COBRA coverage. Your Evidence of Coverage should tell you
who will notify you (the employer through whom you have COBRA coverage
or your health plan providing the COBRA coverage) and what to do to
obtain the extended coverage."
http://www.hmohelp.ca.gov/library/faq/coverage/cal-cobra.asp
Conversion Coverage
http://www.hmohelp.ca.gov/library/faq/coverage/conversion.asp
I'm confident MRMIB are the people your mother needs to contact and I
sincerely hope it works out for her. At the very least, if she falls
through the cracks there, they should be able to advise her. If you
have any questions, please post a clarification request and wait for
me to respond before closing/rating my answer.
Thank you,
hummer
Google Search Terms Used: california cobra act 2003 continuation
coverage "workers' compensation" "medical insurance" |
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