AboutLinda Woolsteen Expertise I can help you with questions about health insurance. If you feel your insurance company is mistreating you. Are they telling you they are checking eligibity, pre-existing, etc. Or you just don`t understand how your insurance works or don`t understand what a PPO is.. I can help you.
Experience
Past/Present clients One company I worked for I was the underwriter for the Academy of Medicine of Cleveland and the Ohio Bar Association. I was also a supervisor of our customer service department.
Question I am recently divorced. My XH has kept me on his health insurance plan the past year. This year his compnay hired an outside agency to determine eligibility of it's dependents and it was determined that I could no longer be covered as a divorced spouse. The problem is however, that I just received notice on 5/4 that my coverage had ended on 3/31. My employer only allows a 30 day window to pick up health insurance so I cannot pick up the insuranc through my employer since I didn't receive the letter until after the 30 days had already passed. The health ins company states that my XH's company informed them that I would no longer be covered as of 3/31. The insurance sent out a letter to me stating that on 4/16 - I did not recieve the letter until 5/4! I'm in MA - the company is in CT. It shouldn't take 18 days for me to receive it. My employer is saying that regardless of when I received the letter, it is past the 30 days and I am not eligible to pick up the insurance. The insurance company says that after the letter is mailed, it's out of their hands and my HX's company should have informed me of the date my coverage ended and my XH's employer is saying it was the responsibility of the Insurance company to inform me sooner that my coverage ended 3/31! Everyone is saying it's someone elses fault but the problem now is mine since I currently have no health coverage and cannot get it until Novemeber (open enrollment). Is there any recourse for me to fight this?
Answer Hi,
I am not sure if I will be of any help on this one but I am going to advise of what my personal feelings are.
First, Your XH's employer is the one that hired the outside company to review eligibility of spouses. It wasn't their Insurance Carrier that did it.
Also, I do know that when an employee leaves a company, it is up to the company to inform that employee about COBRA (Continuation of Benefits), not the insurance company/carrier. Also, the company has to inform the employee with a certain time period.
I personally feel it was your XH's employer's responsibility. Now, with that, I believe you are saying that you cannot get onto YOUR employer's coverage until November since that is when their next open enrollement period is.
There are two things to take into account here. COBRA and a CCC.
COBRA (Continuation of Benefits Act) and CCC (Certificate of Creditable Coverage). Since you will be a late enrollee, you will be most likely subject to a Pre-Existing Time Period. This could be like 12/24 or 12/12 as a couple of examples... which means.... if you were seen, treated or consulted for a condition 12 months prior to your effective date, then those conditions would not be covered for 24 months from your effective date (that would be an example of the 12/24). Your EX's insurance company should issue you a CCC. You will then present this CCC to your new insurance company for possible credit toward the Pre-Existing waiting period. So, if the waiting period is 12/24 and you have been covered under your EX's insurance company for 2 yrs, none of your medical conditions can be denied as a Pre-Existing condition by the new Insurance Company. Another example would be if you were only covered by your EH's insurance for 6 months, then the CCC would say you have 6 months credit toward the new insurance company's 24 month waiting period, so those same Pre-Existing conditions would not be covered until you have gone 18 months past your effective date of the new coverage.
IF YOU HAVE A BREAK IN COVERAGE FOR MORE THAN 63 DAYS.... the CCC is not valid! So, unless you maintain coverage under COBRA... November is going to be past 63 days and you will not be able to use your CCC for any Pre-Existing conditions.
If, you should pick up an Individual policy inbetween such as a Short Term Policy, Insurance Companies are not required to accept CCC's for Individual policies. There was also a story just out in TIME Magazine, March 16, 2009 issue )The Health Care Crisis Hits Home) about a man that did exactly that, took out short term policies, only to have a nightmare when he learned his kidneys were failing ( (I suggest you read when you have a chance) (www.time.com) may be on their website. I read the story in the magazine.
If you do not have any Pre-Existing medical conditions, then you probably don't need to worry to much about that. http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html this page also provides a lot of useful information regarding the CCC, COBRA and HIPAA that you may want to review.
I would write a letter and mail it Certified to your Ex's Employer and CC the Insurance Company that if they don't work together to rectify this situation immediately then you will be calling the CT Department of Insurance. I suppose to fix the situation, they could reinstate you until an appropriate date and with that give you the termination date at the same time, say they reinstate you but that due to eligibility requirements your coverage will terminate on 6/30/09 so that you have your 30 days to inform your employer. I would also in your letter that you send Certified to both of them indicate that "Time is of the Essence" that is always necessary in legal documents when time is an issue. I hope I have been of some help. If you should need anything else, just let me know.
