Employer Cancelled Health Insurance

What is the name of your state? Illinois
I was empliyed with a large corporation for 2 years and in March of this year my individual health insurance was cancelled without notice or authorization. I had no qualifying events and did not authorize the cancellation to my individual policy . Apparently, the company changed administrators and it appears in the change my updated records were incorrectly input dropping my health insurance. I did not notice this from March until May and premiums were not being deducted. I resigned from the company in May. It is now September and our daughter had been in the hospital during late March. They initally paid the calaim and are now are requesting reimbursement. I was wondering if there is any recourse with regards to my employer for dropping my coverge without authorization from me or notifiying me of the change in my health care status. Thanks

[cbg]

Well, for one thing, you say in one place that it was an individual plan but later you're claiming your employer was responsible. Either it was an individual plan, in which case your employer has nothing to do with it, or it was a group plan through your employer. Which was it?

The helath plan was a group plan through my employer. I was trying to be clear that only my policy was cancelled and no the entire gourp plan.

[cbg]

Okay, gotcha. Though it sounds to me as if what you have is a clerical error, rather than your employer sitting back and saying, "Let's cancel JRT's insurance today".

Is that right? Because it makes a difference what action I advise you to take.

Correct, it appears to be a clerical error, compounded by the fact I have since left the company. As previously noted the clerical error resulted in the premiums not being deducted from my paycheck and I did not notice..

[cbg]

Okay.

Part of the problem you're going to deal with is the time span. Most insurance companies will not reinstate retroactively for longer than about two months. While you didn't say so, I inferred from your post that you've been trying to resolve this through the carrier. If so, you've been wasting your time. ( Sorry, but that's the unfortunate truth.)

You need to be working through your former employer, not the insurance company. While I understand what you are saying has happened, it's unclear to me (and it may be unclear to you, too, I don't know) whether the error happened at your employer's end, the administrator's end, or even the insurance carrier's end. In any event, the insurance company CANNOT reinstate you without the approval of your former employer. Depending on how the contract is written, the administrator's approval may also be needed, but it would not be your responsibility to obtain that. Finally, even WITH the approval of the employer and/or administrator, the insurance company MAY decline to cooperate due to the time delay - it will depend on their policies. More on what to do in that case in a minute.

You also need to make sure that they understand that you are willing to make the premium payments that were not deducted during March, April and May.

Contact someone in HR or Benefits at your former employer's office and try to resolve this first. It is MUCH easier to deal with this by reinstatement than by any other method.

Since the ultimate responsibility here was that of your employer, to confirm that all employees were transferred to the new administrator, IF (and I am not saying this WILL happen, but IF) you are ultimately unable to be reinstated, then your employer would certainly have a moral and ethical responsibility to see that you are reimbursed for any charges that would have been picked up by the insurance without this error. Whether they also have a legal responsibility to do so, will depend on your state law, and I don't know how Illinois views this. IF this happens, then I would contact first your state insurance commissioner, and secondly, a local attorney who is versed in either employment or insurance law.

BTW, just so that you know, in the last 25 years I have worked in an insurance administrator's office for three and a half years, for a national health insurance carrier for five years, and most of the rest as an HR Manager or consultant. In other words, I've spent pretty much all of the last 25 years working with employee health insurance benefits in one form or another. So this is not an unfamilar situation.

Sorry I had to be so slow about responding, but it was necessary to know which set of laws applied.

Thanks for the help . I just learned of the situation on Friday afternoon and I have contacted my former employeer who was unsure how this happened as well. They indicated they have launched an inquiry to which I will have a response within 5 days. I appreciate your help. Thanks

[cbg]

If you have any further questions after the investigation is complete, let me know. This does not happen often, but I've been part of trying to fix it on the rare occasions that it does.

Thanks again and hopefully this can be resolved quickly and appropriately.