A child with T1DM is insured under your policy as his parent, and the health insurance usually comes through your job. When your child becomes an adult and enters the workforce, his company is likely to have a group insurance policy that he enrolls in, generally without penalty for being a person with diabetes. No law mandates that health insurance must be provided to employees; in many cases, employer health insurance coverage arose as an incentive to attract employees and keep them with the company.
You can turn to Insurance For Dummies by Jack Hungelmann (Wiley) for more coverage of health insurance than I have room to provide here. This section looks at health insurance specifically as it applies to coverage for someone with T1DM.
When it comes to getting insurance as a person with type 1 diabetes, there are plenty of protections in place if you understand them and know how to use them. One such protection is the Employee Retirement Income Security Act (ERISA), which regulates employee group health plans. If your child has T1DM (or you do), the ERISA rule that you can appreciate the most is that an employer health plan can't discriminate against your child (or you) by refusing to let him join or charging you more if he has an illness.
The Health Insurance Portability and Accountability Act (HIPPA) limits the time that you can be excluded from a company health plan because of a prior illness. That means that if you have T1DM when you join the company, the company must offer you health insurance within a reasonable time if all other employees have it.
There are basically two types of health insurance:
1 Fee-for-service plans pay the provider (a doctor or hospital) based on the number of services provided. It's to the provider's advantage to perform more services.
1 Health Maintenance Organizations (HMOs) charge the same for all members, dividing the risk among more expensive and less expensive patients. The fewer services that the provider actually performs, the more the provider takes home, so HMOs try to enroll the healthiest population possible to avoid the higher costs of sickness.
RBEft It's common for companies to give employees the choice between a fee-forservice plan and an HMO. As someone looking to insure either your child or yourself with T1DM, you need to anticipate using your insurance coverage more than someone without diabetes. Under those circumstances, you need to keep in mind that generally the HMO costs you less but the fee-for-service plan allows you a much wider choice of doctors and hospitals. The following are some particularly important considerations to make and questions to ask about insurance coverage when choosing a plan:
1 What's the total annual cost of the plan? How much does your employer pay, and how much do you pay?
1 Do you have to pay a certain amount (called the deductible) before the insurance kicks in and begins to pay?
1 Do you have a co-payment (an amount you pay every time you use a provider), and how much is it?
1 Will your plan pay for durable medical equipment like an insulin pump, which is expensive?
1 Will your plan pay for diabetes medication and supplies?
1 Is your physician restricted to prescribing certain medications?
1 Can you get a 90-day supply of drugs, or do you have to go back to the pharmacy (and pay another co-payment) every 30 days?
1 Are you covered for specialists like eye doctors, neurologists, and kidney doctors?
1 Are you limited to using certain doctors or hospitals that may not be convenient?
1 Is home health care included?
Each state also has its laws about how medical insurance can be offered. The best place to find the information for your state is the Web site of the Georgetown University Health Policy Institute at ihcrp.georgetown.edu. Go to healthinsuranceinfo.net to access the consumer guide for health insurance for your state. The Health Policy Institute site also has a lot of information about social and health issues that may apply to you, like the Center on an Aging Society and the Long-Term Care Financing Project. It's amazing how much valuable information is at your fingertips!
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