Employer paid Health Insurance nightmare

[diannekw]

What is the name of your state? Wisconsin

My husband was employed with a Plumbing Co. In April of 2006 the Co. was sold and his employment terminated. The former employer had been paying his insurance premiums to the Union Insurance plan. He then became an independent contractor employee with the former employer’s new construction business.

The former employer agreed to continue paying his insurance benefits. Apparently there was some sort of arrangement between the previous owner & the current owner of the Plumbing Co. The Co. was sold to one of the plumbers and they all continued to share the same offices. The wife of the former owner of the company stayed on as an employee with the new Plumbing Co. She has paid the insurance premium for my husband to the Plumbing Union’s Insurance company every month since April 2006.

My husband & I knew we were supposed to go on COBRA after his termination. We all assumed that we were on COBRA, including both the previous and current owner of the company. I realize ignorance is not excuse, however We all thought that was how it was done, because we were told by the Union insurance company that COBRA was the same coverage and everything continued as before.

When taking my daughter to the Doctor in Feb. 2007, after her surgery for follow-up, the statement of patient information stated our insurance was COBRA. I am not sure how they got that information, but I believed everything was as it should be.

The plumber’s Union Insurance has recently made us aware that payments were not going to COBRA. They were just going to the regular insurance.

The matter is going before the Plumbing Union Board of Trustees to determine what is to be done. Technically we have no insurance now and on top of that, my husband was told they may come after “someone” for past benefits paid out, etc. We had HUGE medical bills over the past 2 years – at least $30,000 was paid out.

I am self-employed and have Diabetes. Our only other option is the state insurance program (HIRSP). In order to qualify you need to answer questions like, “Was COBRA offered to you? If it was, did you exhaust COBRA? I have no idea how to answer those questions. Plus, we need a Certificate of Creditable Coverage from our past Union insurer, and we are not certain if they will give it to us. Hopefully they will give that to us, but are still waiting for their answer.

The final monkey wrench in all of this, is that the former employer who has been paying the premiums, is my brother. I am terrified that if legal action is required, we may have to sue my brother - which of course I do not want to do. Nobody did anything intentionally wrong here. What do you think will happen?

[cbg]

COBRA is an extension of the existing plan of benefits. It is not a separate plan.

For record-keeping purposes, some employers and some insurance carriers list COBRA participants separately from active employees. They may even bill them separately and/or assign a different plan number. However, the benefits are exactly the same.

COBRA lasts for up to 18 months. If your husband was terminated in February of 2006, COBRA would only JUST be ending now.

The fact that this is a union plan makes it more complicated. I cannot give you any information on rights that the CBA or the agreement between the two owners may provide. Obviously I don't know what they say.

Ultimately, you're going to have to work this out with the union.

[TIMMAAYY]

Just thought I'd toss this little gem out there, since it's a Union based plan.

If they did any self funding, such as with a 105 plan, the COBRA benefits COULD be different. This is not typical, but it is a possibility.

[cbg]

Which is why I pointed out that I could not address any additional rights provided in the CBA or by the agreement between the owners.

[TIMMAAYY]

But you said:

"However, the benefits are exactly the same." with respect to COBRA...


And that isn't always true.

[cbg]

Under the law, which is what I was talking about, they are.

But I take your point.

However, I will counter that if the benefits are not exactly the same, it is not COBRA, since by definition, COBRA is a continuation of the existing plan.

[TIMMAAYY]

Perhaps we should continue this in another thread... as I am certain you are not familiar with my strategy on health insurance. COBRA is still COBRA.... even if the BENEFITS are not the same. The insurance product purchased is not neccesariy the "benefits" provided.

[cbg]

We're playing semantics now, Tim. Not all benefit continuations are COBRA, even if that has become the umbrella word.

[TIMMAAYY]

It's fun having your statements picked apart word by word, isn't it?