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  1. #1
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Wrong Health Insurance

    What action did you anticipate your employer taking when you brought the matter to his attention? If you did not want him to correct the error, what was your purpose in telling him of the mistake?

    Those are real questions, not arguments.

  2. #2
    Join Date
    Dec 2018
    Posts
    3

    Default Re: Wrong Health Insurance

    Quote Quoting adjusterjack
    View Post
    You should have been on top of that and caught the mistake when it happened. Makes me wonder what else you aren't paying attention to with regards to ANY kind of insurance, not just medical.
    I don't know how I could have known that mistake was made. My employer doesn't have website for employees. Document provided at the time of open enrollment has only 5-6 pages. Insurance administrator's website is rudimentary & doesn't have documents such as "Summary of Benefits", "Evidence of Coverage", etc. Insurance card has Plan ID # (alphanumerical) but no Plan name. I figured out mistake after I received "Explanation of Benefits" rejecting the claim.


    Quote Quoting adjusterjack
    View Post
    What did your employer say when you brought that to his attention?
    I found out about 45 CFR 147.128 today. Intend to email my employer on Monday. Previously they have taken 30 - 35 days to respond to my email. I want to make sure what they are doing is allowed or not.

    Quote Quoting cbg
    View Post
    What action did you anticipate your employer taking when you brought the matter to his attention? If you did not want him to correct the error, what was your purpose in telling him of the mistake?

    Those are real questions, not arguments.
    At that time, I wasn't 100% sure that they had made the error. I requested them to check if I'm enrolled in correct plan. They replied informing me that they have enrolled me in correct plan & backdated it.

    Backdating insurance coverage cannot resolve this matter as I can’t go back in time to receive health care or change choices I was forced to make in regards to receiving and paying for medical services due to lack of coverage as a result of this mistake.

    Right now, 1) I have paid employee contribution, 2) neither received nor will be able to use services that I have paid for & 3) had to pay for covered services out of my pocket due to rejected claim.

  3. #3
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Wrong Health Insurance

    I'm not sure that this would be considered a rescission of coverage given that they did not simply cancel coverage; they also re-enrolled you in the proper plan. I do employer benefits for a living but this is definitely one that I would kick upstairs to our compliance unit; I'm honestly not sure what the proper actions would be here. Tax, what are your thoughts? Mr. K.?

  4. #4
    Join Date
    Dec 2018
    Posts
    3

    Default Re: Wrong Health Insurance

    Quote Quoting cbg
    View Post
    I'm not sure that this would be considered a rescission of coverage given that they did not simply cancel coverage; they also re-enrolled you in the proper plan. I do employer benefits for a living but this is definitely one that I would kick upstairs to our compliance unit; I'm honestly not sure what the proper actions would be here. Tax, what are your thoughts? Mr. K.?
    Interesting point.
    As per 45 CFR 147.128 -
    "A cancellation or discontinuance of coverage is not a rescission if -

    (i) The cancellation or discontinuance of coverage has only a prospective effect;

    (ii) The cancellation or discontinuance of coverage is effective retroactively, to the extent it is attributable to a failure to timely pay required premiums or contributions (including COBRA premiums) towards the cost of coverage;

    (iii) The cancellation or discontinuance of coverage is initiated by the individual (or by the individual's authorized representative) and the sponsor, employer, plan, or issuer does not, directly or indirectly, take action to influence the individual's decision to cancel or discontinue coverage retroactively or otherwise take any adverse action or retaliate against, interfere with, coerce, intimidate, or threaten the individual; or

    (iv) The cancellation or discontinuance of coverage is initiated by the Exchange pursuant to § 155.430 of this subchapter (other than under paragraph (b)(2)(iii) of this section)."

    As cancellation & re-enrollment is not covered by (i) to (iv) so every other situation would be considered a rescission. What do you think?

  5. #5
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Wrong Health Insurance

    I'm not a lawyer; I'm an HR professional with a specialty in Benefits, and I can honestly tell you - I've been doing some form of employee benefits since 1979 and I am stumped on this one; particularly in view of the fact that a Federal judge has just ruled the ACA unconstitutional since the changes made to it by the current administration. I don't know yet how much those rules are going to hold water going forward. I really would prefer one of the lawyers to chime in on this one. pg1067, I'd be interested in your thoughts as well.

  6. #6
    Join Date
    Aug 2013
    Posts
    284

    Default Re: Wrong Health Insurance

    NOT an HR person and NOT a benefits expert (not on the HR side of things anyhow). I will say that the employer's action sound odd. Not the mistake (stuff happens), but the failure to give the employee fairly detailed plan information on just what plan they were signed up for. My understanding is that ERISA has a Summary Plan Document rule that covers this. I have never worked for a company that did not bury you with paper on the medical plan.

  7. #7
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Wrong Health Insurance

    We have that information on our intranet (NOT the administrator's website - our own). Everyone has access to it. No employee ID or password is required. Anyone reading this thread here on EL could go in and find it and read about the benefits we offer. But few of our employees do.

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