What You Know Can Help You Cope

There is a Yiddish saying: “Man plans, and God laughs.”

A marriage turns sour, and divorce rips apart a family.

A seemingly healthy jogger keels over and dies of a heart attack.

A beloved daughter falls victim to schizophrenia, becoming permanently disabled.

An aged parent’s stroke makes her a helpless “child” dependent on her children for care.

None of these events can be foreseen. But some knowledge can help you cope with the disaster or the threat of disaster.

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Question: My husband and I are getting a divorce. We have a 2-year-old daughter. Since her birth, my daughter and I have both been getting our medical coverage through his work. I did not return to my full-time job after my daughter’s birth and so lost my own insurance coverage. As his ex-wife, can I continue to be a recipient of his insurance benefit through his employer?

Answer: You can arrange continued coverage for yourself and your daughter as part of the divorce settlement. For your daughter, you should get from the court a Qualified Medical Child Support Order, which provides for a worker to keep paying for the children’s health coverage after a separation or divorce. For yourself, you need a Qualified Domestic Relations Order. With these orders, your ex-husband’s company will maintain the insurance, continuing to deduct the premiums from his paycheck. Make sure your lawyer raises the issue.

If you cannot reach an agreement with your former spouse to continue the coverage, you can still buy the coverage yourself through his employer. However, you would pay both the worker’s and the employer’s shares of costs, plus an administrative fee of 2%. This coverage is available for divorced people and dependents under the federal Consolidated Omnibus Benefits Reconciliation Act (COBRA).

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Q: My husband, 63, was in a relatively minor accident Dec. 27, had knee surgery the next day and on Jan. 10 he suddenly died. Is there any sort of widow’s benefit to which I might ever be entitled, such as medical care in a VA hospital? I believe that my husband’s medical insurance from the company he retired from will carry me for only one year.

A: Widows’ benefits under the VA system are available only to the spouses of veterans who had been receiving compensation checks because of a disability suffered by the vet during military service. Surviving spouses who have not remarried, unmarried children under age 18, “helpless” children of any age, and students 18 to 23 are all eligible for these benefits. If your husband did not have a service-connected disability, you are not eligible for VA benefits.

Check with the company where your husband worked. You may actually be eligible for three more years of health insurance coverage under COBRA. When a person with coverage through work dies, the widow or widower can continue the insurance by paying 102% of the premium’s costs.

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Q: I have a disabled adult son on Medi-Cal. He receives $818 a month from Social Security disability. How much more can I give him without going over his income limit? Are there particular items that I can pay for that do not count toward his limit?

A: Medi-Cal eligibility is linked to assets and income. You can receive $60 in casual or unearned income each calendar quarter. If you give your son a birthday gift of $50, or some occasional cash, the state authorities won’t mind. But if you give him a steady supply of funds, this is money that could be used for his medical costs, and you could be in violation of Medi-Cal rules. “In-kind” gifts, meaning contributions other than cash, are acceptable provided you don’t pay for everything. You may spend your money toward his housing and utility costs, food and clothing, as long as you don’t pay for all of it. The rules don’t specify any particular percentage or share.

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Q: All of my medical insurance is provided by my employer. What happens if I contract an expensive medical condition--such as a long-term cancer--that creates years of high medical bills after forcing me to stop working for the company that provides my insurance?

A: If you leave a company for illness or any other reason, you are allowed to continue your health coverage for 18 months, as long as you pay full costs plus 2%. After that, if you do not take another job with insurance, you can buy an individual policy. Companies cannot turn you down for the individual policy, regardless of your medical condition. However, there is no restriction on what the companies can charge for this individual policy.

If you are too sick to work, you might be eligible for disability benefits under Social Security. That means a mental and physical impairment preventing you from doing any substantial work--defined as earnings of $500 a month or more. Once you have been collecting disability payments for two years, you become eligible for Medicare, which helps pay doctor and hospital bills.

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Q: I am more and more interested in alternative medicine. I feel that holistic doctors are more likely to look at my whole person for related symptoms and consider my entire health history than regular doctors, who tend to treat me as a “customer.” Conventional doctors, for instance, are never able to recommend a change in diet when necessary to support a treatment. Unfortunately, my insurance does not cover alternative care. Do you know of an affordable insurance that would encourage that type of approach to my health?

A: Employers and HMOs are beginning to acknowledge the growing interest in alternative medicine. But coverage is still in the early stages.

Read the sections in your plan document called “explanation of coverage” or “summary of plan benefits” closely for details of coverage. This is an official document that must be offered to all employees on request. One large employer, for example, will pay for acupuncture visits, but the benefit isn’t mentioned in the general literature given to employees. It is found only in the “summary of benefits” document.

Among the big carriers, Blue Shield said it is offering members discounts of 25% off the advertised rates for a network of qualified chiropractors and practitioners of acupuncture, stress management, massage therapy, somatic education and the use of fitness centers, athletic clubs and health spas. Blue Cross of California said its services include chiropractors and specialists in acupuncture and acupressure. Kaiser said services vary by geographic area and include chiropractic, acupuncture, and guided imagery. American Specialty Health Plans arranges networks offering chiropractic, acupuncture and Chinese herbal medicine as supplemental benefits to health plans and also provides direct contracting with employers.

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Tip of the Month: California has a special program to help families who care for adults with brain disorders--such as Alzheimer’s disease, strokeand dementia caused by AIDS. A network of 11 caregiver resource centers provides advice and care planning, counseling and support groups and limited financial aid. The general number within the state for the California Family Caregiver Alliance is (800) 445-8106, and the state headquarters is at (415) 434-3388.

Local offices include:

* Los Angeles County, (800) 540-4442

* Orange County, (800) 543-8312

* San Diego and Imperial counties, (800) 827-1008

* Inland--Inyo, Mono, Riverside and San Bernardino, (800) 675-6694

The Web site is https://www.caregiver.org.

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This column appears every second Monday in Health. Send your questions, worries, tips, successes or failures in living with the health insurance revolution to Benefits Bob Rosenblatt, Health, Los Angeles Times, Times Mirror Square, Los Angeles, CA 90053. Or e-mail: Bob.Rosenblatt@latimes.com.