Not Informed of Benefits for 7 Months

[MrsMoreno]

The employer pays the premiums, there is zero cost to the employee. As far as what my percentage would be, I don't know - they will not give me that information. This is an issue now for several employees so now I want this information for them too. There is a difference between the employer simply paying the premiums and reporting the hours to cover themselves and getting the enrollment forms (as is their responsibility) for their employees to utilize what they're (the employer) paying premiums on to have access to the insurance and claims on the insurance.

Thank you so much for your help, I really felt lost because I got the run-around from my employer and the union. They are acting like this never happens and that they don't see what the big deal is because I am now enrolled. They are not admitting any fault, nor are they realizing the value that the benefits would have been to the employee during the period they were not provided. It's frustrating. I know they want me to just let it go and forget about it, but it seems purposeful based on the fact that the enrollment forms are not in the new hire packet, so all employees have their benefits delayed for indefinite periods until they investigate for themselves.

[cbg]

I should have thought of this sooner. Do you have a copy of the plan document?

Just to be sure I understand, the employer pays 100% of the cost and there is no cost to the employee at any time; no payroll deduction?

Did you give your notice?

[MrsMoreno]

I am waiting on the plan docs and insurance cards, etc. It's been almost a month now and I still haven't gotten anything from the insurance co. I pay union dues but the union claims that it has nothing to do with benefits. No payroll deduction as far as premiums but I'm still unsure about my portion of cost - one of my co-workers says she has gotten a bill every time she has gone, I just wonder if it's informational or an actual bill. Another issue I was waiting on my insurance for is my feet (constant pain on the sides of my feet. I'm pretty sure it's plantar fasciitis and that it's work related but we get pressured into using our insurance and saying it's not job related). The reason is that once you go to a Dr. for something before your company insurance kicks in, it is considered a "previous condition" and will not be covered. Since I couldn't get an answer from anyone on whether I was covered or not I just waited. Now that I am enrolled I want to go, but am nervous about the work comp thing. This whole thing is ridiculous.

[cbg]

There's a difference between your employer paying the cost of the insurance, and your paying a co-pay or co-insurance when you use it. Right now, I am only concerned with who pays for the insurance itself, not whether you pay a portion of the bill when you have medical treatment.

It is exactly because of the pre-ex that I am concerned about this.

I'm traveling today and they're calling my flight so I'll have to go more into detail later.

[cbg]

Okay, sorry about that. I didn't have internet access for the rest of the day. I"m back now.

Workers comp claims do not get submitted under your personal health insurance. If you have a workers comp claim, there is a special policy your employer has that covers that. I understand that your employer doesn't want you to use the workers comp insurance but it's illegal for him to refuse to let you.

There are rules about when a condition can be considered pre-ex and when it can't. Unfortunately, because of this gap of 7 months it is *possible* for a condition to be considered pre-ex. That's why we're going through this exercise in the first place. Not all policies include a pre-ex clause, however. Do you know for an absolute fact that your employer's policy does, or are you assuming it? (That's a real question I need you to answer.) If you know, how do you know? Is it because you've seen the wording yourself or because someone told you? Again, I'm working on something specific here.

[MrsMoreno]

I was told by a co-worker that the insurance we get does not cover pre-ex conditions. And I'm 99.9% sure that the employer pays 100%. There is a big deal with this right now in SoCal because the grocery stores are trying to make the employees pay for their benefits and the workers are set to strike in 72 hours if there is not an agreement made otherwise. I will get on the phone and have the insurance co explain what my policy is regarding pre-ex and whether I pay anything just to be totally sure I'm giving you the proper info.

https://www.blueshieldca.com/bsc/fin...arn/faqs.jhtml

^ Explains the PPO's pre-ex policy.


I have Blue Sheild PPO, employer pays all premiums.

[cbg]

The insurance company will not know if you pay any part of the premium. That's a matter strictly between the employer and the employee.

If you are certain that the employer pays all premiums, we'll take that and go from there. There is no such thing as an insurance policy that pays 100% of everything so we will assume that you pay the occasional co-pay or coinsurance.

The pre-ex clause in that link you've posted is pretty standard, assuming that it applies for your specific policy.

[MrsMoreno]

I have $35 copay, $600 deductible and am responsible to pay 30% up to a certain amount (I believe it was around $12,000 in network).

Per the union trust, employer pays 100% of the premiums.

[cbg]

You have a 30% coinsurance and a $12,000 stop loss IN network?

Either you have a really crappy policy or that's not right. I could believe that out of network, but that's a HORRIBLE in network plan design.

Which makes it that much more important that we have an idea how much you've had to pay out in claims that would have fallen under the policy. I'm still concerned about pre-ex, especially if you are planning on leaving. Depending on the plan design of your new employer, that might solve your problem altogether or compound it.

[MrsMoreno]

The lady that was explaining it to me was speaking very fast and since I am pretty unfamiliar with some of the terms, it is very possible I mixed up the numbers on the stop loss. One number she quoted was $12,000 the other was $7,000. But for sure I am responsible for 30% with a $600 deduct. As far as seeing what I would have paid if I used this insurance, I still can't say because I've not heard back from Medi-Cal regarding my claims with them. And I didn't go for things I would have because I was waiting, unsure when I qualified. I have decided to just stay with Medi-Cal though. My new job is only part time and I would make little enough to still qualify. The plan my new job offers is probably pretty close to the one I should have had at my old job but they don't even pay the premiums. Knowing how much I would have had to pay, I probably wouldn't have gone.

I'm officially putting my 2 weeks in today.