insurance cancelled

[singdance65]

What is the name of your state (only U.S. law)? New Hampshire

I received a check in the mail today refunding my insurance premiums as of 1/1/09 (it's March 13). I called the benefit service center for my employer (who is based in Illinois) and was told that the payment I sent for Jan/Feb premiums was 8 days past the grace period for January. My premium checks have all been cashed and I thought I was covered through March.

I was told I can appeal, but I have had no coverage since January and won't again until my appeal is accepted. If it isn't accepted, I won't have any coverage until open enrollment in November (meaning next year). I've worked for this company for 20 years and have never had a problem before.

My question: What should I write in my appeal? I don't plan to cash the refund check and plan to continue to make premium payments until this is settled.

Thanks for your help.

[ecmst12]

IMO it's pointless. They have no reason to reinstate you if your payment was late. There is nothing you can say that would obligate them to do so.

Now I will say that I have never heard of an employer sponsored plan that required employees to mail premium payments and still followed the open enrollment rules. In fact, open enrollement is specifically for plans where the premiums are deducted, pretax, from your paycheck. There is no prohibition against enrolling or dropping coverage at any time during the year for plans which are paid by you out of post-tax funds. So why can't you just re-start coverage now?

[cbg]

FYI, Open enrollment is not SOLELY for pre-tax plans. Where I am now, we have open enrollment for our retirees, who may or may not be having deductions taken from their pensions or who may or may not be billed for the premiums (their choice) and in the days when Section 125 plans were just coming into being, I have had open enrollment for plans that were post tax premium as well. Additionally, I just was able to change my individual, non-employer sponsored insurance plan to a better plan for the same money during the new carrier's open enrollment period.

Open enrollment is mandatory for Section 125 plans. They are optional, but allowed, for non-125 plans.

While the LAW does not prohibit a plan from adding or subtracting employees or dependents during the year for a non-125 plan, the plan document can and often does.

[singdance65]

ECMST2: Here's the confusing mess...

In my workgroup's contract, there is a provision for "voluntary furlough," for a designated period of time, which the company is required to offer before issuing involuntary furloughs. They also have to continue to provide insurance while you are not working. I think this was agreed to when times were good. I'm sure they will try to get rid of it during the next negotiation period.

Anyway, I took a six-month (ends May 2nd). During this time, I'm being billed for my premiums, which were normally deducted from my paycheck. No problems until now.

Our union let us all know at the beginning of the furlough that Benefits was having problems with outdated addresses, etc., and assured us that nobody would lose their coverage. I received a notice about my missing the grace period for January and that my benefits were cancelled AFTER my check for Jan/Feb was cashed, and then the one for March went through, I thought Benefits was still clearing up the confusion. After receiving the refund check, I thought it would be in my interest to find out if I really didn't have coverage, or if they are still getting everything straightened out.

I'll call them again on Monday to ask about being reinstated, especially since I am technically current on my premiums. I hope this whole thing will end in my getting coverage back, but until then, I don't think it would hurt to go ahead and appeal.

What do you think? What would you do if you were faced with this (besides hope that you don't get sick)?

Thanks. I appreciate the help.

[singdance65]

CBG: Same question I asked ECMST2. What would you do if you were faced with this situation?

I appreciate any and all feedback.

[singdance65]

I mean ECMST12. Sorry about that.

[ecmst12]

I think you need to let your union work for you now. They may have the clout to get this straightened out in your favor.