In this open enrollment season, with hurricane season still going and winter around the corner, would you know what to do about your health insurance in the wake of a natural disaster? The recent hurricanes on the East Coast and wildfires in California have many families of children and youth with special health care needs/disabilities wondering what we would do if we were in any of the disaster zones and in need of life saving medications or medical equipment that required health insurance coverage.
Georgetown University Health Policy Institute’s blog: The Center on Health Insurance Reforms (CHIR) offers suggestions in answer to questions families might have regarding their marketplace health insurance. We have tweaked the information to make it specific to Connecticut and following will also apply to families who have private health insurance (health insurance purchased outside of the marketplace or provided by employer)
- What to do if you have to evacuate and your child’s doctors are not close by
Each marketplace health plan will have policies and procedures for reimbursing out-of-network providers (providers that are not under contract with your health plan). Since you may not have access to your health plan documents, calling the health insurance company and asking about your specific situation may be the best option. The contact information should be on your health insurance card. If you don’t have access to your health insurance card, contact Access Health CT:
1-855-805-4325/TTY: 1-855-805-4325 Website: accesshealthct.com
You can also contact Infoline 211: Dial 2-1-1 from anywhere in Connecticut or outside of Connecticut dial: 1-800-203-1234. You can also call your town local health department for assistance. That list can be accessed through the following link: www.ct.gov/dph/localhealth
You may also contact CT’s Insurance Department at: 1-800-203-3447 to determine if there are any declarations or proclamations issued by the Governor regarding waiving any restrictions or penalties on members going out-of-network for necessary health and dental services on a non-emergency and emergency basis.
In emergency situations, the Affordable Care Act requires insurers to provide coverage for out-of-network care and prohibits insurers from charging higher coinsurance or copayment amounts for out-of-network care than for in-network care. The ACA, however, does not prohibit medical providers from billing consumers the “balance” of their charges after an insurer pays a portion of the charges.
- What to do if you’re evacuated, far from your local pharmacy and need to fill your child’s prescriptions
You should contact your health insurance company or Access Health CT and ask about your specific situation. You may also contact the Connecticut Health Insurance Department to find out about any bulletins or recommendations for insurance companies to allow their members up to a 90-day supply of prescriptions regardless of when they had their prescription filled.
Maintaining Marketplace Coverage
- Unexpected bills due to natural disaster that will affect you from affording to pay your health insurance premiums. What are the consequences of not paying?
If you can’t afford to maintain your coverage this year, you should contact Access Health CT: 1-855-805-4325/TTY: 1-855-805-4325 as soon as possible to terminate your coverage and if applicable, stop receipt of any premium tax credits. You should also contact your health insurance company to ensure your health plan is terminated. Make sure to document the dates of your contacts with the marketplace and the insurer.
Note that not paying your health insurance premiums without terminating your plan could limit your ability to sign up for 2018 coverage in the marketplace. Under new policies, insurers may condition your re-enrollment in their plan on payment of any outstanding premiums. However, insurers must provide notice of the new policy before they can apply it to you for failing to pay premiums. Also, the policy only applies to the insurer to whom you owe outstanding premiums. Other insurers offering plans in your area cannot deny you coverage for failing to pay premiums to another insurer.
- Do I qualify for an exemption to the individual mandate (the requirement to maintain insurance coverage) or will I have to pay a penalty for being uninsured?
Access Health CT offers individual mandate exemptions but to qualify and in order to avoid a tax penalty you may be asked to fill out a hardship exemption application. Read more here-insert CT exemptions doc. For floods or disasters causing substantial damage to your property and keeping you from paying for your health insurance you may be asked to provide a copy of a “police record, insurance claim or other document including a news source” about the event.
If you receive a hardship exemption, you become eligible to purchase catastrophic coverage, which may be less expensive than a marketplace plan. You may want to consider this coverage to protect yourself financially if you have an unexpected illness or injury. This type of coverage will provide for coverage of emergency or catastrophic health events, but note that catastrophic health plans have much higher out-of-pocket costs like deductibles when you want to use your coverage. You also cannot use any federal premium tax credits to purchase a catastrophic plan.
In Connecticut, in the instance of a natural disaster, Access Health CT would likely set up an “exceptional circumstance” special enrollment period (SEP) for individuals residing in or moving from federally-declared incident areas.
In the wake of all the recent natural disasters, and tragic active shooter events we encourage all families to develop and practice a family emergency and evacuation plan that also includes a plan on how to how to access your healthcare coverage. As we have witnessed tragedy can happen to any one of us at any time. Whether its evacuating our homes due to a fire or weather-related event or while we are outside enjoying a community event we have learned that we must have a plan in the event that tragedy strikes. Children and youth with special healthcare needs/disabilities are even more vulnerable in these situations and these families will have greater evacuation needs which require careful planning.
In the early spring of 2018, PATH Parent to Parent/Family Voices of CT will host a discussion featuring a panel of disaster and emergency preparedness experts who after hearing family stories and needs will help them figure out how to plan, what to do and where to go. Stay tuned for more information in the coming months.