Human Resources/cobra coverage
I am an employee and live and worked in New Jersey for a Nationwide Bank
I have been on long term disability benefits since 12/29/2009 due to Alzheimes/Social Security Dis since 6/1/2010 and medicare since 6/1/2012 due to disability. Enrolled in medicare medigap coverage 1/1/13 and supplement for my wife who has been on medicare since 2/1/11 based on retirement.
Have been paying premiums to "Leave Management Department" for Group medical,dental,vision and life by check each month to employer. Terminated 12/31/2012d due to expiration of leave of absence.
Did not pay premium for group coverage in December which covered payroll periods beginning 11/19 thru 12/29 cause i believed premiums being billed were for January group coverage.
Received letter from "Leave Management" 1/18 dated 1/10 requesting payment for December premiums with notice that if not paid my coverage will be terminated eff 12/1/12 and wont be eligible for Cobra.
Called Cobra Center 1/18 and advised of failure to pay December premiums and was assured it had no affect on my rights to enroll in Cobra. Enrolled over phone and elected dental coverage only and opted for direct debit and immediately sent check for cobra first month's month which was promptly cashed by my employer. Also mailed check for December premium for Group Dental coverage only which was also cashed on 1/25/13. Received written confirmation of cobra enrollment dated 1/13, verified coverage effective 1/1/13 over Internet and received enrollment cards from Delta Dental.
Received premium notice for 2 months COBRA premiums dated 1/21/2013 and called on 1/30 and spoke to Lauran who confirmed first premium paymentwas received and second payment would be taken from Direct Debit.
Just received check dated 3/1/13 in mail for "refund of you payment for benefit coverage" and "Benefits Confirmation" issued 2/12/13 showing dropped group coverage effective 12/1/2012. Contacted Cobra Department and was advised Cobra coverage cancelled for voluntary termination of group coverage for non-payment. Explained Cobra Center advised me failure to pay premium for December had no bearing on my eligibility for COBRA and I was advised that it was done because the COBRA center was given incorrect information. Not sure by who but I certainly give any incorrect information. (I had asked guy twice if it had any affect and was told he was "absolutely certain."
Premium sent for Group Dental Coverage only was cashed and never returned. Websites for both Group Medical and Dental now show termination of group coverages effective 12/31/2012.
As of 3/8/2013 both the medical insurance and dental insurance websites are showing my coverage ending 12/31/2012 however the dental plan paid a claim on 2/12/13 for services rendered on 2/5/13 and the medical plan paid a claim on 3/1/2013 for services rendered on 12/18/2012.
My wife has not received any notice of termination of coverage in her name.
We have incurred over $3,000 in dental expenses for my wife in the past month in reliance on this coverage. The information contained in the COBRA package makes no mention of any requirement for the continued payment of group premiums and says I must elect my COBRA coverage no later than March 3, 2013. I openly and voluntarily disclosed the fact that I had not paid the December group premium and was advised and reassurred that it had no impact on my Cobra rights (wrote his name down) and the COBRA information clearly indicated that any questions regarding insurance coverage through COBRA be directed to them. Because of the discrepancy of opinions between Cobra center and Leave Management I even paid the group dental premium and the check was cashed and never returned. Coverage cards were issued and a claim was paid on 2/12 for dental work done on 2/5 and a medical claims was paid on 3/1 for expenses incurred on 12/18. I am being told by employe that group coverage was terminated effective 12/1/12 but insurance company websites now say coverage ended 12/31/12.
1) Does the lapse of coverage of group insurance due to non payment of my group coverage affect my right to enroll in COBRA?
2) If so, does the employer's acceptance of my dental insurance premium and failure to refund the premium give me the right to enroll in COBRA
3) Does the fact that both the medical insurance and dental insurance websites now show my coverage expiring 12/31/12 help my case
4) Does the fact that both medical insurance and dental insurance paid claims incurred after the date the employer is saying my coverage terminated help my case
5) shouldn't I have been able to rely upon the coverage cards sent to me and my wife for dental coverage
6) shouldn't my wife have received a notice that her cobra has been terminated.
7) do i have a valid reason to dispute their decision and how would you recommend I do so- send them a letter? file a complaint with the Department of Labor and/or State Insurance Department? Have my attorney send a letter?
This has been a nightmare to navigate especially since we were also in the process of navigating the medicare supplement nightmare during open enrollment not to mention that I suffer from Alzheimer's Disease. I had no idea I needed to pay the December premium in order to enroll in COBRA and was given conflicting information by either leave management or Cobra department and the information being given to me by my employer does not seem to be the same as the information being shown by the insurers regarding the end of coverage date.
My wife's dental claim has not been declined but I believe it will be shortly.
I don't really trust my employer anymore. They initially declined my LTD claim on the basis of a paid consultant doctor's opinion that never examined me that there was no objective evidence to support my disability and I had to spend thousands of dollars in legal and medical fees to document my disability. I do not know what to do next.
Sorry to be so verbose but this is a very important and complicated situation to sort out.
Thank you for your question. Unfortunately, your question is a five headed monster. All the detail you offered doesn't allow a fast reply and required me to draw up a timeline and flowchart..... likely I will have to follow up with more questions before I can advise you. In fact, it will likely take a good amount of time for me to research and get back to you. Keep in mind this is a FREE site on AllExperts.copm and I am not here full time :). Also I'm not an attorney.
Let me see what I can do after reading over your entire question; and all of it's many subparts, and I will reply to you again with a followup response to your less than topical question.
Thank you for the vote of confidence. In the end, it may be easier for you to call me at toll free 866- 285-2746. If I don't reply here before Friday March 15th, call me to discuss.