Carolina Quoter

Avoid Lapses in Your South Carolina Health Insurance Coverage

Having continuous health insurance coverage is considered by many to be very important. However, there are certain times in one's life that might bring about a loss or lapse of coverage. Situations like a job loss, a career change, or death can result in a loss of South Carolina health insurance coverage for the whole family. Because most households are covered under one member's insurance, the burden of coverage lies on the individual who is covering the entire family via their employer's medical plan.

There are solutions to avoid lapses in health insurance coverage. When someone gets laid off or terminated from employment, he/she is offered an extension of coverage through COBRA (Consolidated Omnibus Budget Reconciliation Act). Although Cobra in South Carolina is usually much more expensive than a group insurance plan offered by an employer, sometimes it is the only option. Though, it is usually best to find an individual policy because it might be less expensive. An individual policy is one that is obtained by one's self and is not apart of a group as it is with a company.

One stumbling block to obtaining individual coverage or any plan after you have lost medical coverage with a different company, employee, or health insurance carrier is the preexisting conditions clause that many insurance companies enforce. This preexisting conditions clause states that you cannot be covered for medications, procedures and/or consultations for a condition you had before the new plan started. This is very difficult for individuals who have a condition that they need to be seen regularly for. At times, these conditions are not covered and one is stuck to pay out of pocket for this/these condition(s). And, not only can the insurance company refuse to pay for these preexisting conditions, they can also deny you coverage altogether if you suffer from a condition that can be considered preexisting.

In South Carolina, there is protection from the above mentioned situation if you have had no more than 2 months without coverage; that protection is HIPAA (Health Insurance Portability and Accountability Act). This legislation restricts health insurance companies from denying coverage or failing to pay claims based on preexisting conditions as long as the individual seeks and/or obtains coverage within 2 months of the last day of coverage with the previous plan.

Although the protection is there, it is a better idea to plan ahead if you know there will be a lapse in coverage. This, however, does not apply to unforeseen circumstances like the sudden loss of employment that was not known ahead of time. If the individual is knowledgeable of an upcoming loss of coverage, it is best to plan ahead to fill in the gap; much frustration will be avoided if it is approached in this way.