Deanna did very little actual work on her first day. Most of her time was spent getting situated at her desk, setting up her voicemail and email. Then there was the orientation meeting with the HR person who seemed to speak faster than an auctioneer going over her tax forms, retirement and health benefits.

“Let me know if you have any questions,” the HR person said at the end of her talk.

“I will, I will,” Deanna said, retrieving the stack of paperwork she needed to fill out.

Deanna went back to her desk and started to pore through all the material related to health care benefits. Skimming through the list of providers in the doctor-directory, she came across a particular rheumatologist that she’d heard good things about. Unfortunately, the doctor didn’t accept Medi-Cal patients like Deanna. In order to see him, Deanna would have to enroll in her employer’s HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) health plans. But she feared her bipolar condition and arthritis would brand her as having what insurance companies call a “pre-existing condition,” meaning she couldn’t get private health coverage. Deanna considered asking the HR person for advice, but she felt a little uncomfortable having to disclose personal details to a new co-worker. So, during a break she called Ruth and explained her dilemma.

	Deanna could keep seeing her therapist under her new employer's PPO plan.

Ruth told her that not only could she easily enroll in one of her employer’s health plans, she’d still be covered by Medi-Cal as well. Indeed, Deanna did have a pre-existing condition, which would affect her eligibility. Employers typically required a new worker to stay on the job for a minimum time period—like 90 days—before deeming him or her eligible for health coverage. In bureaucratic lingo, this was called the service wait. Practically everyone, even if they didn’t have a condition, had to endure the service wait. Once the wait is over, then comes the initial enrollment period. This is a window of opportunity when employees can enroll in health coverage without their past medical record being held against them—in other words, the best time for someone with a pre-existing condition to sign up for health care.

Depending on the type of coverage, people like Deanna with pre-existing conditions might have to endure an extra exclusionary period during which they couldn’t get coverage for those conditions. For instance, California law allows PPOs to impose a six-month pre-existing condition exclusionary period on people like Deanna; self-insured plans can impose a one-year period.

In Deanna’s case, her history with Medi-Cal actually helped her. Ruth explained that a federal law (the Health Insurance Portability and Accountability Act or HIPAA) would allow Deanna to use her Medi-Cal coverage to reduce any pre-existing condition exclusionary periods she might face. This wouldn’t help with the shelter’s HMO plan because group HMOs in California don’t have exclusionary periods. However, if Deanna opted for the PPO, the federal rule would totally eliminate the 6-month exclusionary period for PPOs.

Deanna breathed a sigh of relief. “Thanks again, Ruth.” She hung up and started filling out her paperwork. She went with the shelter’s PPO plan, which seemed more flexible than the HMO alternative. She’d still have to make it through the three-month service wait, but that seemed reasonable to her. After she finished signing everything, Deanna marched in to the HR rep's office and handed over the stack of forms.

“Wow,” the HR lady said, “that was fast. Guess you were paying close attention earlier.”

“Yep, guess I was.”