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Seven Tips for Making the Most of
Insurance Plans
1.
Will my child be covered under my health insurance
plan at work?
Ask your employer if your health plan has dependent coverage. You may have to pay extra for the coverage, but it is usually much less than buying an individual policy for a child.
If your employer offers choices of group insurance, select the one that will pay the most medical expenses. It will cost more, but with a child with a chronic condition, you will most likely benefit from such a plan.
Finally, if you have a spouse who works at another company that offers health-care insurance, compare the two plans to determine which plan is better for your family.
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What Should You Look For in an Insurance Policy?
Coverage for
arthritis: Pay attention to whether the plan denies coverage for your child's type of arthritis. The general policy provisions will seldom exclude coverage for arthritis, although an individual policy may specifically exclude it.
Outpatient and inpatient care: Look for a policy that provides a benefit for doctor visits and other outpatient services, as well as for surgery and hospital care. The plan should cover any type of recognized surgery to relieve pain and promote function.
Choice of doctor: If you buy a managed care policy, such as those offered by a Preferred Provider Organization (PPO), an Exclusive Provider Organization (EPO) or a Health Maintenance Organization (HMO), you may be limited to seeing only the health-care providers in the plan network. Make sure you will be able to get care from specialists, such as pediatric rheumatologists, when you need them.
Rehabilitation coverage: This type of provision should include physical, occupational and vocational therapy. Also look for coverage for assistive devices, such as braces, splints and wheelchairs. Carefully evaluate any limitations on these benefits.
Prescription drug coverage: Ask to see the insurance plan's "formulary," which is a list of drugs the plan will cover. Make sure your child's current medications are on the list.
Laboratory and other monitoring procedures: These procedures should be covered not only to diagnose problems, but also to ensure that your child's medicine and other therapies are working effectively.
Costs: Weigh the benefits for the policy against the costs. Costs include the premium, deductible, copayment,
out-of-
pocket cap and annual as well as lifetime maximum benefits. Also look to see if some benefit levels are reinstated each year.
Health plan report card: Check to see if a consumer group has rated the health-care plan for customer satisfaction and quality of care.
Service: Call the insurer's customer service phone number to see how quickly you can get help.
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2. What if I must buy an individual
policy?
If you need to supplement your group coverage with an individual policy, or if you don't have group coverage, shop around for an individual policy. One tip: Look for a policy that will continue after your child is no longer your dependent.
3. My employer doesn't have a health
insurance plan, and I can't afford
to pay for an individual policy.
How can my family qualify for
Social Security benefits?
The Social Security Administration has two programs that may pay benefits to the families of disabled children: Social Security disability insurance and Supplemental Security Income
(SSI).
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Social Security Disability Insurance. This is a program that provides money to disabled workers. A child disabled by arthritis can receive benefits under this program if his or her parent covered by this program retires, becomes disabled or dies. In addition, the program may apply if your child is over 18, was disabled before age 22 and remains disabled.
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Supplemental Security Income (SSI). Although SSI is best known for providing assistance to senior citizens with limited finances, it also provides a monthly benefit for disabled people - including children - whose families have limited income and resources. The disabling condition must be expected to last at least 12 months and must meet certain other criteria.
The Social Security Administration can assist families who are unsure if they qualify for either of these benefits. To begin the process, contact any Social Security Administration office. To find the office closest to you, call 800-772-1213 or visit their Web site at
www.ssa.gov/kids. Follow the links to "Parents" and "Benefits for Disabled Children."
4. What state programs can help?
Medicaid, Insure Kids Now and vocational rehabilitation services are three examples of assistance that may be available from your state.
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Medicaid. This program is designed to help cover the medical costs of families
with few financial resources. Eligibility requirements vary from state to state.
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Insure Kids Now. This program is open to children age 18 or younger. Generally,
uninsured children in low-income households are eligible. The program has
different names in different states. For more information, call 877-543-7669 or visit their Web site at
www.insurekidsnow.gov.
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Vocational Rehabilitation Services. Most states provide some form of financial aid through this office to qualified youths with disabilities who are 16 and older. For example, your child might receive assistance with college tuition, self-help aids and job training.
Finally don't forget to check into religious and volunteer groups that help kids with special needs. Your
local chapter of
the Arthritis Foundation a can guide you to these and other sources of assistance. To locate a chapter near you, call 800-283-7800.
5. What happens when my child is no longer eligible for my health insurance
plan?
Some insurance plans will cover a child who is in school until ages 18 to 25. This age range may vary among policies. By this time, the child may have a job that provides health insurance, or your plan may allow the child to convert coverage to his or her own name. If none of these options are available, your child may be able to apply for SSI and Medicaid, as described above.
6.
My child is receiving SSI and Medicaid benefits. Will college financial aid
or job income affect these benefits?
Additional income could potentially lower or cancel a child's SSI and Medicaid benefits. However, when your child turns 18, your income and resources will not be counted when Social Security figures the child's benefits. In addition, most scholarships or grants used to pay for educational expenses are not counted as income.
If your child is working, he or she may continue to receive SSI payments until the child's income exceeds the SSI limits. Medicaid payments will usually continue, even if the child earns more than the SSI limits, if the child cannot afford similar medical care and depends on Medicaid to work.
In addition, certain work expenses related to the child's disability may be subtracted when his or her income is calculated to for SSI purposes. For example, if the child needs a wheelchair or modifications to a car in order to work, these would be considered work expenses and would not be counted as part of the child's income.
7. Can my child save money and still keep his or her SSI benefits?
Social Security's Plan for Achieving Self-Support (PASS) program allows a person with a disability to set aside income or resources for a definite period of time to reach a work goal. For example, your child could set aside money for education, vocational training or starting a business. The money saved would not reduce the child's SSI payment. The child's plan, or PASS, must be in writing and submitted to the Social Security Administration for approval. For more information about the PASS program, visit
www.ssa.gov/pubs/11017.html.
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