Health Insurance Disaster- Please Help!

[tristanlh]

What is the name of your state?
Alaska

In August I found out wonderful news, I am having a baby! Then I found out not so wonderful news- my insurance would not cover any maternity or labor costs. My boyfriend and I had been planning a wedding which was still a year away, but when we found this out we decided to get married so I could be added to his insurance, which does cover maternity.

On October 16th we were married. We submitted the insurance paperwork to his employer on November 29th, at which point his employer (actually the Owners wife who does the insurance) said to him, Gee I hope this is within the 31 days you have to file this paperwork. Alarmed, my husband asked her What 31 days? At which point she explained (for the first time) that we had 31 days from the date of our marriage to add me to the policy. It had been 45 days from the date of our marriage and this was the first time we were hearing about this.

Of course, the insurance company rejected my application because it was not within the 31 days and said I would have to wait until the renewal anniversary, which conveniently enough for them is next May (I'm due in March). I was and am understandable irate about this matter and demanded that the Owners wife write a letter to the insurance company telling them that we were never notified of the 31 day policy. I just found out that they are still rejecting me.

I am so upset about this I am in tears and unsure what to do. On one hand I'm not sure if I should be mad at this woman, who never told us we had 31 days, or the insurance company.

Any Help?

Thank you.

 

[cbg]

With all due respect, you should not be mad at either of them. Instead, you should be mad at yourself and your husband for not asking how long you had to add a dependent to the insurance. It was YOUR responsibility to find out how much time you had. It was NOT the responsibility of either the employer or the insurance company to seek you out and tell you this. After all, they had no way of knowing that the only reason you were getting married at that time was for the insurance benefits.

If the insurance policy is under a Section 125 plan (if your husband's portion of the premium is taken pre-tax or if he has the option of taking it pre-tax, it is) then it is the law that you only have 31 days to add a dependent, and it is the law that if you miss that window you have to wait for the next open enrollment period, which is traditionally the beginning of the benefit year. Even if it is not under a Section 125, the employer still is required to follow the terms of the insurance contract, which almost certainly has the same restrictions on it. Neither the employer nor the insurance carrier has any legal obligation to violate the insurance contract because you assumed you could add a dependent any time you want to.

A letter from the company telling the insurance carrier that you were not notified that you only had 31 days, is going to do exactly nothing since your insurance company is just as aware as your employer that YOU were the one responsible for asking the question, rather than that of your employer to tell you.

BTW, it is almost certain that the information was in the insurance SPD, if you'd read it.

Sorry, but there is no legal way to force either the employer or the insurance carrier to add you to the policy now.

 

[tristanlh]

I apreciate your response, but do not apreciate your assumption that the ONLY reason my husband and I were marriend was to "reap the insurance benefits."

Thanks.

 

[enjay]

My boyfriend and I had been planning a wedding which was still a year away, but when we found this out we decided to get married so I could be added to his insurance, which does cover maternity.

CBG didn't assume anything. You stated that you got married early so you could be added to his insurance.

 

[cbg]

I don't believe I said anything about "reaping the benefits". But referencing the same quote enjay mentioned, I'd like to know how else I was supposed to interpret it. I didn't say that was the only reason you got married; I said it was the reason you got married AT THAT TIME. And I got it directly from your statement.