Wow my Wifes company, which we have our health insurance through ,sold out and told the employees that they have insurance for 2 more weeks. And it will be 90 days before they can apply with the new owners insurance. Im on Enbrel and MTX and they said COBRA would be $1200.00 per month. I cant let my insurance lapse because my P would then be concidered "preexisting". But I cant afford the Enbrel and MTX and I also cant just stop those. I have to wein off. Any ideas on what to do?

Call Enliven services and see if they can't help you out on the Enbrel cost. Their number is 1-888-4-Enbrel.
Hope you can figure something out soon!
Tig

Hi Golddoor,
Yikes! I'm sorry to hear about that. Tiggity's suggestion that you call Eliven service's is a good one. You also might want to check out some of the assistance programs that have been discussed here on the Board. We don't know very much about most of them, but they're certainly worth looking into.
A couple of years ago, during a prior discussion of high Enbrel co-payments, a new poster -- who sadly came and went quickly from the Board -- mentioned (here's a link to her post: ) a co-payment assistance program called Patient Services Incorporated or PSI. According to their website, PSICall Enliven services and see if they can't help you out on the Enbrel cost. Their number is 1-888-4-Enbrel.
Hope you can figure something out soon!
Tig
Just got off the phone with Enliven and they said they cant help. The lady I talked to seemed clueless. She said they only help patients with no insurance period. Or people with insurance to pay Copays!

I don't think that's true -- that your P would be considered preexisting and not covered under COBRA. COBRA is a continuation of the coverage you had before, not new coverage. IF that covered Enbrel, then COBRA should as well.
It doesnt matter. I cant even afford close to $1200 a month!!

Gold: I have been in health insurance for 27 years. I am also ao former medical practice manager who was responsible for employee benefits, and your post alarmed me because something not right.
Here's what I see:
1) The company MUST UNDER FEDERAL LAW cover you for at least 30 days from the date they close, and BY THE LAST DAY offer you COBRA. 1200.00 is off the wall, and Im sure that's NOT WHAT THEY WERE PAYING for their employee's montly. Check to see how much her premiums were prior to this because even if premiums were taken out, the company is only responsible to pay up to 10% twoards her monthly health insurance premium. This would have meant that she was paying almost 1000.00 from her check????????? I doubt it.
2) It sounds to me like they are "Cancelling" the current coverage, and offering you COBRA under a new plan. THEY ARE NOT ALLOWED TO DO THIS, AND THEY CAN BE VERY HEAILY FINED Especially if there are more than 20 full time employees.It sounds like they are giving you an option of a new health insurance plan, that's the only way there would be a pre existing clause. UNDER FEDERAL LAW they must offer a CONCURRANCE of the existing plan....Something is very wrong.
Here's what I would do: Call the labor department. Tell them that a buyout is occurring, and you feel that there's something wrong with the employee benefit provisions, and that "correct" COBRA benefits are not being issued to you.
The continuance of medical benefits when an employer sells or closes a company does not happen the way you are describing, and that's how I know something is wrong. The law was specifically designed to protect you from this. Start making phone calls my freind, somebody is doing something wrong.
Ihurt

Golddoor: IHurt has given you some good advice on this because they are not allowed to cancel the coverage without allowing you to pick up Cobra.
It was my understanding that if you are carrying insurance for more than one individual, that you must carry the same type of coverage - within Cobra, except if you encounter a qualifying event, say a legal separation and or divorce - then Cobra can kick in at the single rate.
My employers plan costs $321.50 for single and $870.00 per month to insure more than one in a household. Add on the 2% admin cost - and that would run about $17 which would make Cobra from employer $887.00. Now rates are based on many factors within a group and if your employers group has a very poor health history or is small, I could see where this could run $1200 per month.
Personally, I know a couple who are in the high risk pool for BCBSNC who pay $2400 per month for their health premium.
Although the above doesn't help you, I didn't find $1200 to be terribly unreasonable. But again, I would make sure that your employer was on the up and up as they can only charge you what the actual plan cost is + 2%.
Regarding Enliven - I called them before regarding assistance. They have very strict guidelines and I believe that the representative said that you could not have insurance AND you must make less than 34,000 per year to even be considered. What a joke.
My friend, try to do what you can and do whatever it takes to protect and keep continuous coverage.
Michael

Why do companies do these things???? My thoughts and prayers are with you, however I wish we as a community of psoriasis patients could do more for situations such as this. If there are 4 to 5 million of us in the USA, is there a possibility of establishing an emergency fund to which we could contribute within this Foundation? If 5 million people donated $5 per month, until the fund had a large balance that could fund these situations with its earnings, wouldn't we all have less to worry about and in turn, less psoriatic flares? Something to think about.

IHurt and MichaelaCFP - Thanks for the info. How exactly does COBRA work? On Monday im going to be calling some people and finding out about all this. I didnt think that sounded right. But my wifes been the one doing the talking to her company. She claims thats what they told her? so I guess I will have to call her HR and find out about it for myself. She works or worked for Hilton Hotels so they have way more than 20 employees. And whats BS is the new companies insurance is with the same insurance company that the Hilton had. Both companies offer Aetna. Whats up with that?

Gold - The Hilton Corporation has a lot of employees and I would imagine that they have a fairly good rate premium rate due to the fact that their "rate pool" consists of younger workers. Based on that information - I would almost be certain that the plan costs them much less than $1200 per month per family.
COBRA is federal legislation where an employee (and family) has the right to maintain current coverage if the employee leaves the job to take another job OR if the employee takes extended leave and the company is unwilling to pay the premiums for the employee.
When negotiating a new contract with an insurance company, 99% of the time, the company negotiates with the inference that "employee pre-existing conditions" do transfer to the new insurance and employees get credit for any waiting period time based on their "length of service with the company."
Your idea of calling HR over at Hilton tomorrow is a good one. If you are not satisfied with the reps answers, ask her for the corporate headquarters phone number and speak with a member of HR, there. Unless the Hilton which your wife works is franchised - there is absolutely no way that Hilton would expose so many employees (from a pre-existing condition standpoint,) when switching insurances.
Cheers,
Michael

COBRA is federal legislation where an employee (and family) has the right to maintain current coverage if the employee leaves the job to take another job OR if the employee takes extended leave and the company is unwilling to pay the premiums for the employee.
Michael
Michael, When you have the right to maintain coverage, is that the same coverage, with the same insurance company, and at the mothly premium without the employers copay? For example if say we were paying 400.00 per month in premium then go on COBRA. What should the premium be then?

Gold:
Michael has now given you great advice. Aetna Insurance company has four plans/products that they sell. Even they know that when the company sells, the pre-existing clause is 'grandfathered in" because of the length of employment. This 90 day waiting period should not even apply, and the benefits should just transfer over in this case because Hilton employs more than 100 employees and isconsidered an EOHC (equal oppotunity employer) under the Federal laws.
Calling HR is a good idea. One thing to be careful about is allowing the new owners to change the policy from the one you have to one less costly (eg: a PPO to an HMO plan).
The only other thing I woud investigate is whether or not Hilton is "self insured" and Aetna is just their "processing agent". This could impact premium rates, and would account for why the new owners are giving a rate of 1200.00, and then this would too be illegal. What this would mean is that actual claims are paid by Hilton when they come in, and Aetna is just providing a service of processing the claims. However, if the old owners could afford the claims at those rates, the new owners could do so as well, and as Michael has pointed out the assumption is that the covered population is young and in good health.
Good luck, and please do let us know how you make out!
Ihurt

Gold: The COBRA premium should be approximately up to 10% more than what your wife was originally paying, plus the 2.00 administrative fee.
Companies that contribute to the employee health plans only do so up to 10%. Not sure how much Hilton is contributing, but it should beno more than ten percent.
YES, it should be the very same coverage...no changes.

Gold - Cobra Administrative charges are capped at 2% of the premium rate. This 2% is typically charged by the employer and not by the Insurance Company.
Sometimes, plans and conversions are a little bit complicated, thus, please call your employer's HR tomorrow and get as much information as you can. If you are not satisfied that your questions are being answered go ahead and gently explain your situation (Do not go into specifics because the HR rep does not have your health information, by law he/she is not allowed.) Say something like: I have a pretty expensive prescription drug which I am currently on and could you give me some guidance as the most cost effective way to transfer to the new plan while keeping my current RX coverage.
Once you receive her answer, ask her about how much the current premium under cobra would be? Is this what the insurance company is currently charging per month? What about Aetna - can I transfer to an individual policy and maintain my current benefits?
Gold, I have been in similar situations and have always found a reasonable work around where I did not lose coverage. If for some reason things do not work out here, the next avenue would be to immediatly locate a clinical trial that would be accessible to you.
Keep us posted.
Michael

Hilton said that coverage ended the day of sale. And that the COBRA is being offered through the old plan. The Hilton paid 65% of the monthly premium. So our monthly COBRA plan is still going to be about 1000.00 per month.
They didnt give my Wife or any of the Employees any notice? All in one week, with no written notice, they told everone they were selling, and already sold out to the other company. We havent even recieved anything about the COBRA. They said it coming? In the mean time, I got signed up with Unicare for a short term coverage ,but they dont pay for any preexisting so I am curious if since they dont pay for pre existing on the short term, if it will tranfer still to the new group plan in 90 days without pre existing issues?

Hi Gold,
Most lawyers offer a free, one hour consult. Call one. Today is December 23, 2005 so the 2 week period should be up soon. Since the company won't provide the forms to sign up for the COBRA option, send a letter and pay the extra 35 cents for delivery confirmation that states you elect the COBRA coverage and want the forms and a bill for the insurance amount. Send it today.
When my son turned 22, he was not eligible to be on my insurance, but we could elect COBRA coverage with the same benefits, except I had to pay the full premium. All preexisting conditions were covered. I was given a form, and it had to be completed and received within 30 days from the day his coverage ended. That was the rule with my insurance. After that expired, by law, he could continue with Blue Cross and although it was a somewhat different plan, if he paid higher premiums, they could not exclude preexisting conditions. Since he damaged his knee as a runner and had several surgeries to repair it, he had to opt for that. So to convert to Cobra, you should be getting an application form and an exact insurance premium quote.
A good employment attorney or one that handles disability claims should be able to explain your legal rights and tell you what to do. If you can't speak to one today, at least get it in writing and postmarked today that you elect the Cobra coverage, to protect your rights. Don't worry about how to pay for the 3 months of Cobra. You'll get the assistance you need. Just hurry and sign up for it is my advice.
Ann

Thanks for the info and advice Ann. I went ahead and contacted the Labor Dept today and found out that they are doing everything by the book. Hilton has 45 days to offer COBRA. And they did say that COBRA would cover my preexisting conditions. They also said that the Hilton does have the right to cancel my insurance at anytime. Yes they must offer COBRA but there is no law in Texas that says they must keep us covered for 30 days past closing date. Im just going to go with the cheaper short term Unicare plan for now and pray that everything works out until I can start my ENBREL again in 90 days!

Call Enliven services and see if they can't help you out on the Enbrel cost. Their number is 1-888-4-Enbrel.
Hope you can figure something out soon!
Tig
Yes, they are sending it to me free so i would suggest them also. I have recieved my first shippment(8 needles) but i haven't started it yet because i'm affraid of all the warnings. Yeah call them and good luck. It's all based on your income so make it seem low.

Yes, they are sending it to me free so i would suggest them also. I have recieved my first shippment(8 needles) but i haven't started it yet because i'm affraid of all the warnings. Yeah call them and good luck. It's all based on your income so make it seem low.
What did you say to get yours free? How did you go about it?