Exclusively Denied Company Health Insurance Coverage

[jakesmom]

My most recent employer has a company sponsored health plan, there are two plan choices. There exists, a summary of benefits sheet that outlines the two plans. My issue is that I was an employee for in excess of 90 days (contract prior to that) and had no knowledge of the plan(s). When another employee told me that it existed, I inquired about the plans, eligibility etc. from the bookkeeper. This is a small operation 2 pawn shops with 6 employees. We discussed my interest and I told her that I'd like to be added to the plan. After two phone calls and a couple of e-mail transmissions, I was not only never enrolled into the plan as she indicated that I would and subsequently terminated. What are their consequences for being exclusively excluded from the benefit? Not only did I not have coverage while employed as I could have, but also no COBRA coverage because she never added me to the plan.

Thanks

[cbg]

What were the eligibility requirements as defined by the plan documents?

Federal law limits when an employee can and cannot be added to the plan.

[jakesmom]

The only eligibility requirement is/was 90 days of full time employment. As stated, the bookkeeper never said that I wasn't eligible in anyway, in fact tried to cover herself "you were contract so I didn't think about telling you that we had insurance".. when I asked her via phone, she said, "hum, let me check and see if she's mailed me back she's usually very prompt".. In a nutshell, I quickly got the feeling that after reminding her for a month, that I was being put off intentionally.

She and I even discussed my part of the premium as an employee.

[cbg]

I just want to make sure that I understand correctly before we go on to the next step:

You were an employee for 90 days or more? The 90 days does not include any of the time you were a contractor?

[PattyPA]

And by "contractor" do you mean independent contractor or an employee of a staffing agency who paid you during that period?

[jakesmom]

I am sorry, it is complicated. I was initially contract, then added to the employers payroll as a salaried employee. I had met the 90 requirement as a bonafide employee when I was made aware of the plan and began inquiring about how to enroll etc..

[cbg]

Okay, thanks for clarifying. That helps. One last question, and it really does make a difference to what recourse you have; how long after you met the 90 day requirement were you let go?

Sorry I didn't ask that initially - I only realized after the fact that I would need that information.

[jakesmom]

I had worked 22 days over the 90 period. Keep in mind that I didn't find out that it was even available until the first part of February and that's when I began inquiring for more details. I recall counting the days when I found it that it was available and was just under the wire so to speak. If you need a more specific date on that I think I have supporting e-mail.

[cbg]

Okay, this is going to be tricky and it's not necessarily going to work in your favor. Technically, you have 30 days after you first become eligible to enroll, and if you apply within those 30 days, it's retroactive to the date of eligibilty. Since the 30 days were not up yet, it's going to be a hard call to claim that they violated anything. They could have enrolled you any time within the next eight days, had your employment continued, and it would have been exactly the same as if they'd enrolled you the very first day you were eligible.

Additionally, since there were only 6 employees, the Federal COBRA does not apply, and even if you had been enrolled in the plan on the very first day you were eligible, you would not be eligible for the state continuation, which requires that you have been covered for three continuous months prior to termination.

We don't know from here when coverage would have ended, but the odds are overwhelming that it would have been on either the last day of employment, or on the last day of the month following termination. This means that given the most favorable circumstances possible, you would have been covered from your 91st day of employment till the last day of the month in which your employment ended, and possibly not even that long. If I am reading your post correctly, this means that the best possible result would have been your being covered for 30 days.

You can run it by the Federal DOL if you want to, but I don't think you've got much to go with here.

[jakesmom]

I reminded her by e-mail on February 17 one exact week prior to my termination date. I had also asked reminded her by phone as stated in my original post but don't remember the exact or if it was before or after the 17 e-mail. Thank you again.