A Couple of Benefit Questions

[marymary]

These benefit matters really stress me out, I'm sure you all have been through the same or similar struggles.

We are evaluating small Group coverage with Blue Cross (PPO w/ $30 co-pay), this would be through husband's employer.

There is a pre-existing conditions clause, as follows:

"If an employee or dependent applies for coverage within 180 days of terminating coverage in a group health care plan, Blue Cross will credit the time enrolled IN THE PREVIOUS PLAN toward the preexisting condition waiting period"

My question is, what if you were enrolled in a succession of plans, never experiencing a lapse in coverage? Would the preexisting condition waiting period still be waived? In my situation I was enrolled in Health Net through two separate employers (going from most recent backwards) One (1) month in new plan with the new employer; Three (3) months of COBRA coverage with the old employer, and a year + with the old employer.

Also, does anyone know if Blue Cross PPO covers Gamma Knife treatment?

Basically I am finding that the PPO option is quite costly, with a $ 4,000 Annual Out-of-Pocket Maximum. Since we are already in October, that would basically mean $ 4,000 in 2006 and then again in 2007. Add to that the premium cost, of which the employer would pay 50%. I have not yet received the premium cost. I will learn that tomorrow.

This employer does not offer an HMO feature. I'm not sure that Medicare would be any less expensive, however. I am currently only enrolled in Medicare Part A (the part you can't turn down), due to my current enrollment in a Health Net HMO. I honestly don't know very much about Medicare coverage.

I am feeling guilty and sad that my husband's acceptance of this job offer is hinging on my need to be in an HMO. We are both feeling the stress today.

Any comments and feedback is welcome from all you benefit gurus out there.

Thanks.

Mary