Posted 9/11/2007 4:57 PM (GMT -6)
I work for an HMO, and they actually cannot drop you if you already have coverage. What they can do is include a pre-existing clause in a contract for new subscribers. That would mean that they would not need to cever payment for pre-exstong conditions before signng with the plan. However, that clause cannot remain forever. t is regulated by state not to exceed a certain timeframe. Some selffunded plans have more lattitude as far as dening certain conditions, but once enrolled, and covered, HMOs cannot just drop you because they do not want to pay. They can make it difficult in some cases with medical necessity, but denials for that reason for UC would be difficult to uphod. Some employers can refuse to cover a person bsed on the number of employees and the self funded contract, but ven that could get nasty for the employer.