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  • Insurance Laws?

    My neighbor is in deep distress. Her husband who works very hard 40+ per week for the same company X plus years has been without medical insurance all this time. His employer told him that it would cost him (employer) to much to take care of employee's illness. Employee is diabetic, and spouse is asthmatic. Medical bills are for syringes, asthma spray, and whatever else they need when they are sick. They also pay for a primary care doctor who now says husband needs a specialist. Even with all their hardships, this couple is not on welfare or any govt. program. Unfortunately, they are illeterate and was shame to tell of their plight.

    I am not an expert in this feild nor close to it. I tried searching at a site. All it gave me is how to find a quote for insurance. Isn't there a law that says it is mandantory for employers to get medical insurance for employees? I think the employer in this case is copping out of what is supposed to been done many years ago.

    Your insight to this matter and recommendations is greatly appreciated. MAMA keeps telling me to MYOB but I can't. I pity very easily, especially when someone is being taken for granted.

    Lynn
    Be AKAMAI ~ KOKUA Hawai`i!
    Philippians 4:13 --- I can do all things through Christ who strengthens me.

  • #2
    Re: Insurance Laws?

    Grrr! Stuff like this really makes me mad.

    Here is a link to the health insurance laws in Hawai'i. It says that if someone works for a company for 20 or more hours a week, they are entitled to health insurance, and the company has to pay for half of it. Even if the employee is sick, he cannot be denied the opportunity to buy health insurance if he works at least 20 hours a week.

    If your friend is low to moderate income, he and his wife might be able to qualify for assistance via the Quest program. There are only a certain number of slots available in this program, so if it's full, he won't be able to get it.
    "...To be eligible for Hawaii Quest coverage, you must meet eligibility requirements. You must be a Hawaii resident and a U.S. citizen or qualified alien. In addition, you must have a social security number. You must be under age 65 and you must not be blind, disabled, or living in a public institution. Your income must be below 100% of the federal poverty level, although the income limits are higher for pregnant women (185%) and those under the age of 19 (200%). In addition, you must have limited assets. Finally, you must not be eligible for health insurance from your employer unless you are receiving welfare or general assistance benefits.

    • Hawaii Quest has an enrollment cap. If enrollment in the program is full, no new applications will be taken. However, certain residents are eligible for Hawaii Quest without regard to the enrollment cap. These people include foster children, pregnant women and children with household incomes up to 185% of the federal poverty level, people who lose employer-sponsored coverage when they lose their jobs, and certain others. Contact Hawaii Quest for more information about eligibility and enrollment...."

    If he has problems paying for his insulin and asthma drugs, he can talk to a State Health Dept. social worker who can try to get them on a free drug plan.

    Hope that helps a little bit. One of these days, this country is going to get akamai and guarantee that every citizen gets health care.

    Miulang
    "Americans believe in three freedoms. Freedom of speech; freedom of religion; and the freedom to deny the other two to folks they don`t like.” --Mark Twain

    Comment


    • #3
      Re: Insurance Laws?

      Miulang, Mahalo. You should be a lawyer/psychiatrist/politician!

      I just got back from Kaiser. I'll go tell my neighbors about the laws.

      Talk story laters.

      Lynn

      Ok. I'm back. According to the Mrs., none of the employees are covered by insurance. All work 40+ a week. The problem is if they file a complaint, they probably lose their jobs. Taxes and other deductions are being taken out. Perhaps they should just purchase insurance on their own even if the employer is unjustly doing wrong to all his employees.

      I feel like going down to the job site and giving him one of my Auntie Lynn whack whacks!
      Last edited by 1stwahine; July 5, 2005, 05:07 PM.
      Be AKAMAI ~ KOKUA Hawai`i!
      Philippians 4:13 --- I can do all things through Christ who strengthens me.

      Comment


      • #4
        Re: Insurance Laws?

        doesn't that mandatory law affect those companies that have five or more employees? Other than that I believe employers of less than five employees aren't required to cover them.

        One thing about health insurance companies is that most won't cover pre-existing illnesses (including pregnancies) but will cover for future medical costs once insured.

        With that said if your neighbor's employer has more than five employees then they have to provide some sort of subsidized health insurance coverage. All affected employers are required to do, is to provide health coverage for it's employees. If your neighbor needs additional coverage to include his/her spouse then that neighbor must pay for additional spousal or family coverage.

        What a lot of companies are doing now is to incorporate their businesses into smaller LLC's or Limited Liability Corporations where each LLC is like their own company all the while under one parent corporation. This reduces the total number of employees to each LLC.

        So lets say a company has 24 employees working in six departments. This company converts each department into LLC's effectively making each department it's own company but still under the auspices of the parent or umbrella corporation. Since each new LLC has only four employees on it's payroll guess what? No need for insurance coverage.

        Sounds cruel and it is but that's how small companies get around this requirement to provide health care.

        So what does your neighbor do? I'm afraid that even if the husband can get insurance thru his employer, the insurance company won't cover any medical claims for a pre-exisiting medical situation.

        Why do they do this? Simple math. It's cheaper to pay for 20% of the cost of a doctor's visit than 100% if it's indemnity coverage (such as HMSA/UHA) or a standard office visit charge of less than $20 if it's an HMO such as Kaiser.

        A similar situation would be car insurance. You drive with no insurance and hit someone's home creating $30,000 dollars in damage to their living room. You don't have $30-Grand so you apply for car insurance at a rate of $100 per month and you buy one month's worth of insurance. You then file a claim against this accident that already happened and the insurance company pays the $30,000 claim against you. Your cost: $100. Ummm I don't think so.

        No insurance company will pay out on a pre-exisiting situation. It is for that reason that insurance companies won't cover you for that but will sign you up for coverage for new or undiagnosed conditions.

        This is why a lot of insurance companies will require a medical physical to determine if you're hiding a pre-exisiting condition. This is why insurance companies will require a vehicle or house inspection before issuing you car or homeowner's insurance. They will cover you for future incidents or conditions but will not cover you for pre-existing ones.
        Life is what you make of it...so please read the instructions carefully.

        Comment


        • #5
          Re: Insurance Laws?

          Mahao Craig, The husband works for a landscaping contractor. I don't know how many employees there are but I bet it is less than five. It's such a shame that people like my neighbors try to work and are not on any govt. assistance. They live paycheck by paycheck. Even if he is sick, he works. She beg me to help her cause she's afraid of losing her husband. I promised I would cause I know what it is to lose a husband.

          Lynn
          Be AKAMAI ~ KOKUA Hawai`i!
          Philippians 4:13 --- I can do all things through Christ who strengthens me.

          Comment


          • #6
            Re: Insurance Laws?

            I know it's tough but realistically the bottom line is that you work for an employer for income. If you're lucky it can be for benefits too. However we need to be responsible for our own medical needs. It is for that reason that your neighbor should seek government assistance.

            Believe it or not, my wife and I plus six boys qualify for certain government assistance such as WIC (since I have a toddler) despite the fact that I own a nice home, two cars, a pension, IRA's, investments, and she works as a manager for Headstart. But I felt as long as we can afford to be on our own without government assistance, we should leave it for someone who truly needs it, like your neighbors.

            You should insist that your neighbors look into these subsidies as a way to help them out. They paid into the system, they should be able to use it now that they need it.
            Life is what you make of it...so please read the instructions carefully.

            Comment


            • #7
              Re: Insurance Laws?

              Craig, Once again thank you for the information you shared. I will look into what govt. programs they can qualify into. There must be something for them.

              Lynn
              Be AKAMAI ~ KOKUA Hawai`i!
              Philippians 4:13 --- I can do all things through Christ who strengthens me.

              Comment


              • #8
                Re: Insurance Laws?

                Originally posted by 1stwahine
                Mahao Craig, The husband works for a landscaping contractor. I don't know how many employees there are but I bet it is less than five. It's such a shame that people like my neighbors try to work and are not on any govt. assistance. They live paycheck by paycheck. Even if he is sick, he works. She beg me to help her cause she's afraid of losing her husband. I promised I would cause I know what it is to lose a husband.

                Lynn
                The employer can also probably get away with it if the husband isn't considered a permanent employee. Usually with landscaping lidat, it's considered a seasonal job (although since you guys don't really have winters there, that's kind of a stretch). Like Craig, I would tell the wahine to check into the Medicaid Quest program, and also check with the State about the free drug programs some pharmaceutical companies offer (I think Glaxo, the guys who make insulin, are in that program). Also like Craig says, I know sometimes it's hard to ask for this kind of help, but tell your friend if she doesn't at least look into these programs, somebody else will benefit. Would be different if it wasn't about saving your life. You and I are paying taxes so people like your friend can at least try to stay healthy.

                Miulang
                "Americans believe in three freedoms. Freedom of speech; freedom of religion; and the freedom to deny the other two to folks they don`t like.” --Mark Twain

                Comment


                • #9
                  Re: Insurance Laws?

                  Tita Miulang, I got to help her cause unfortunately, she is unable to do it. She has a big heart. I know I already have responsibilities but all it takes is calling and finding out what resources are available for them. You and Craig have put me on the right track to follow.

                  Lynn
                  Be AKAMAI ~ KOKUA Hawai`i!
                  Philippians 4:13 --- I can do all things through Christ who strengthens me.

                  Comment


                  • #10
                    Re: Insurance Laws?

                    i wish you luck lynn in finding help for them. what a frustrating situation. stories like that one just makes my blood boil. don't wanna be too unfair but this system of capitalism really bothers me sometimes. of course, our government does everything it can to perpetuate this myth and protect "our way of life" but what a system it is. competition vs cooperation. i don't doubt that it "works" on certain levels but it certainly appeals to the natural tendency to think of me vs. us. sigh....

                    please let us know how it goes....
                    525,600 minutes, 525,000 moments so dear. 525,600 minutes - how do you measure, measure a year?

                    Comment


                    • #11
                      Re: Insurance Laws?

                      In today's StarBulletin http://starbulletin.com/2006/07/09/news/story05.html

                      "Agencies unite for the needy"
                      Various groups aim to ensure that a new law will not deprive Medicaid recipients of benefits
                      By Helen Altonn

                      "Nearly 40 government and community organizations are working together to make sure no Hawaii Medicaid or QUEST recipients lose benefits because of a new federal law.

                      The law, which went into effect July 1, requires all people who renew or apply for the health insurance programs to show proof of U.S. citizenship and photo identification."

                      I hope and pray it's not anything like what happened to the elderly with the Medicare Fiasco! http://hawaiithreads.com/showthread....light=medicare

                      Auntie Lynn
                      Be AKAMAI ~ KOKUA Hawai`i!
                      Philippians 4:13 --- I can do all things through Christ who strengthens me.

                      Comment

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