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  1. #1
    Join Date
    Aug 2008
    Posts
    2

    Question Health Insurance Error

    My question involves labor and employment law for the state of: VIRGINIA

    Earlier this year I was made aware of an apparent mistake made by our company with regards to our Health Savings Account (HSA) - PPO Plan with Virginia's CareFirst Blue Cross / Blue Shield.

    Last October (2007), our company, who is on an October to October "plan year" cycle, began offering the CareFirst HSA PPO family plan with a deductible of $5400.00, of which I signed up for - even though I had a pending baby due. The baby was born 21 December and of course consumed the $5400 deductible. As expected, all charges after the deductible had been met was paid by the insurance company.

    This past February I noticed that Blue Cross "restarted" my deductible accumulation (set at 5400.00) as of 01 January back to zero, wiping away any amounts I paid during the first three months of the plan year. After inquiring, it was explained by my company HR folks that once I filled out a form and turned it in with our CareFirst Eligibility of Benefits (EOBs) statements, any deductible amounts accrued from the beginning of the plan year - 01 October 2007 to 31 December 2007 would be carried over to the next calendar year, and we could complete our plan year, deductible met. However, it that was not so, at least according to the health care provider CareFirst.

    After much debate, my company agrees that they were in error. They apparently signed a "calendar year" contract with CareFirst instead of the normal "Plan Year" contract of October to October. However, the company has refused to make amends with regards to the new $5400.00 deductible I have had to meet to cover the period of January 2008 to October 2008. My cost for health coverage have far, far exceeded the original $5400.00 I had to pay in accordance with the original documentation the company presented and I signed up for. It is a shock that after having a baby and obviously meeting my 5400.00 deductible, that that deductible was only good for 3 months - now I have to start over. This will make my plan year cost $10,800.00. The company certainly apologized for the error, however I strongly feel that they should pay an amounts due that exceed the originally advertised $5400.00. What is the company's responsibility in this and shouldn't the employee be better protected? They are not "required" to provide fringe benefits. However, they should be required to provide complete, honest and accurate information with regards to any benefits they do offer.

    Any insight and/or assistance regarding this matter is greatly appreciated. I am ready and willing to go to court over this matter!

  2. #2
    Join Date
    Feb 2008
    Posts
    1,179

    Default Re: Health Insurance Error

    I was hoping someone else would have a good answer for you...but here are my thoughts...

    Does the employer fund any part of the HSA for you?

    Do you have any of the communications literature that states the original plan year (october to october)? If the premiums fall under a Section 125 plan, you should have also received a Summary Plan Description. Did you get one and did you keep it? I suspect by now, the company would have revised it...so you would need to look for an original.

    If you do have written documents, I would check with the insurance commissioner in your state as to whether there are any remedies. Here is a link: http://www.scc.virginia.gov/division...oiconsumer.htm

    That said, taking your current employer to court is usually a career limiting move. It is possible that you might be covered under anti-retaliation/whistleblower laws....but I am not sure. You might want to speak with an attorney who is familiar with employee benefits.

    Obviously someone in HR made a mistake. Calendar year contracts are much more prevalent than off year contracts. It would honestly be an easy mistake to overlook especially if they went with a new plan/provider. I just don't know what laws would require them to correct their mistake. I am going to send you a private message with a link to a forum that might be more beneficial for benefits questions.

  3. #3
    Join Date
    Aug 2008
    Posts
    2

    Post Re: Health Insurance Error

    Thanks for the response.

    1. Does the employer fund any part of the HSA for you? - Yes. They funded a total of $1400 to be applied toward the $5400 deductible.

    2. Do you have any of the communications literature that states the original plan year (october to october)? - Yes. I have maintained dutiful documentation of this issue, including lots of documentation regarding our deductibles being carried from the previous calendar year to the current as per a "plan year to plan year" contract.

    3. Taking your current employer to court is usually a career limiting move. - Not applicable. After this issue, several employees left the company.

    Any other assistance anyone can provide would be greatly appreciated.

    R/
    Oky

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