A few days ago, I received my letter denying me long term & short term insurance coverage. The letter stated, “As you know, the insurance you are applying for is medically evaluated and certain health standards must be met to be eligible for enrollment. Another review has been made of the insurability applications you completed. Based on your condition of insulin dependant diabetes diagnosed 1989, it has been determined that our original decision to deny Short and Long Term Disability insurance coverage cannot be changed. Other pertinent health history includes high blood pressure and acid reflux.” The letter goes on to state I have 90 days to appeal this decision. I must say I HAD this insurance and dropped it shortly after starting at The State of Texas. Does this mean I will never be eligible or should I fight this with an appeal? I can brag and say I don’t call in sick (very often) and do a great job at work. I work 13 hour days and have a 2 year old son!!!!!!!!!
Answer
When the employees pay all of the premium or part of the premium (and employees can waive out making participation less than 100%) then the insurer will usually require proof of good health in order to become insured. This is perfectly legal and common practice. Whenever you have a pre-existing medical condition, you should never drop coverage until you are approved in writing for new coverage. Coverage is not guaranteed and worse, you now have a denied code registered with MIB which is a warning to other insurers. Any way to get that other coverage reinstated?
A few days ago, I received my letter denying me long term & short term insurance coverage. The letter stated, “As you know, the insurance you are applying for is medically evaluated and certain health standards must be met to be eligible for enrollment. Another review has been made of the insurability applications you completed. Based on your condition of insulin dependant diabetes diagnosed 1989, it has been determined that our original decision to deny Short and Long Term Disability insurance coverage cannot be changed. Other pertinent health history includes high blood pressure and acid reflux.” The letter goes on to state I have 90 days to appeal this decision. I must say I HAD this insurance and dropped it shortly after starting at The State of Texas. Does this mean I will never be eligible or should I fight this with an appeal? I can brag and say I don’t call in sick (very often) and do a great job at work. I work 13 hour days and have a 2 year old son!!!!!!!!!
Insurance companies have the right to reject you. It’s not fair but that’s how it is.
Well, unless there’s some major revamping of the law, or your employer changes it’s disability carrier, it’s pretty likely you will never be eligible.
Disability is NOT health insurance – so they don’t HAVE to take you just because you’re part of the group.
That’s the problem with dropping some types of coverages – it can be impossible to get them back. I don’t think you have any grounds for appeal on this, but you can try if you want.
Dude… Insulin dependent diabetes? Other than cancer, heart problems, or AIDS, there is no condition that will get you turned down faster. There is no reason on earth why you should appeal this. It’s perfectly legal to deny you this coverage, and disability plans are one of the more difficult plans to qualify for medically. I’ve seen 20 yr old women in perfect health declined for being on birth control.
The thing is, these coverages are almost always offered to employees on a guaranteed issue basis, but only once. At the initial enrollment for all eligible employees, and every year subsequent to newly eligible employees.
Whether or not you work 13 hour days, or have a child will be completely irrelevant to obtaining coverage, so I’d leave that alone too.
The only way possible I can see you obtaining this coverage, is to get a new job that offers long and short term disability, buy it in your first year, (to avoid health questions) continue to work for the company until you can port your product, (usually one full month’s payroll deduction) and switch to a bank draft, so you don’t ever miss a payment. Never let it lapse. The thing is, finding a job that offers this may not be easy, you’d have to spend several months at that job as well to become eligible, enroll, wait for payroll deductions to start, and then wait one more month. It’s probably not worth it.
Unless it’s guarantee issue, it is legal. If you really want coverage, check out Assurity and Lloyd’s (Peterson International). Offers will hinge heavily on your level of control (high blood pressure and diabetes don’t mix well FYI).
Good luck