Pre-existing medical condition of immigrant child

TA | November 5, 2008

Q: I am an Indian Citizen on an H1 B visa here in California. My son who is 2 years old needs continuous medical treatment for neurological issues. I am finding that the insurance company wants to exclude any medical conditions that have occurred in the last 6 months. I work for a small company and they are ready to help me out, they are even ready to change the provider for the whole company if that helps me getting some help for my child. I work in the technology industry but I came to this country so that I can get my son treated. Please do let me know if there is any way that i can get medical coverage for my son.

A: Sorry, we do not know of any insurance company that will immediately pay for the costs of known medical issues for a new immigrant to the U.S. Only one supplemental insurance plan called Core Health Insurance provides limited doctor visit benefits after one month but this is not meant to be a primary coverage. California's "Healthy Families" health insurance program and U.S. commercial health insurance is specifically designed to discourage people from coming into the U.S. to seek more expensive medical treatment for chronic medical conditions than was available in their country of origin. This is the reason you are faced with a 6 month waiting period.

Changing employer health plans will probably not help since insurers are only required to match the pre-existing condition coverage that existed before under federal HIPAA and COBRA law. Additionally, a change of insurance companies would mean higher insurance rates for everyone in the company due to the higher expected costs of the group now including your son. The increase in the company's insurance premium would need to be more than the cost of care for your son in order for the insurance plan to maintain the same medical expense/premium ratio. (This is because of the somewhat bizarre medical billing system in the United States where the insurance company negotiates a discount to medical bills and charges plan members with the overhead for this service and administrative functions).

If your employer wishes to help then the smartest approach would be to spend the additional funds directly for medical care rather than in higher insurance premiums.

Although it is likely little consolation to you at this point, a six month waiting period in California is more generous than most immigrants find throughout the United States. This comes as a surprise to some people who come from a country with a socialized universal health insurance program.

Fortunately no one goes without basic medical care in the U.S. regardless of insurance. While your child may not get the same level of constant care as under a commercial insurance plan, almost all hospitals in California have an indigent care program. You will not be turned away due to lack of insurance if your son needs emergency neurological care during these first six months.

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