Insurance cancelled without notice

[markinsalem]

What is the name of your state?What is the name of your state? Massassachuttes

I have a situation I hope someone out there can help me with.

My former company shutdown 12/31/04 and notified all employees via email. Today I find out that our health insurance was cancelled on 12/16/04.
My problem is that I had an accident on 12/27/04, I blew out my knee, and now need surgery to repair my ACL.

What are my options? I know very little about insurance, so any help would be appreciated.

I did search an found a refernece to __Sentara Virginia Beach General Hospital v. LeBeau v. A.S.G. Inc.__ but have been able to find little else.

[cbg]

When were you notified of the company closing?

[markinsalem]

Thanks for the reply,

I was notified on 12/31/04 that the company was shuting down.

[cbg]

Okay, that leads to another question, but one that you may not know the answer to since it relates to the administration of the benefits.

A "benefits month" with regards to health insurance, is not necessarily the 1st to the 31st. The benefits month can run from the 7th to the 6th, or the 23rd to the 22rd, or any other day of the month to the one preceding it i.e. February 7 through March 6. Do you happen to know if, by any chance, what the benefits month is?

[markinsalem]

I just got a reply from the HR person regarding the "benefits month". The reply say's the benefits month was from 12-1-04 - 12-15-04. (seams like a short month)

Thanks in advance,
Mark

[cbg]

Mark, I'm doing some research on Massachusetts insurance law and any notification requirements. It's been several years since I worked in the insurance industry and I don't know if things have changed since then. Bear with me while I check - it may take a couple of days. Meanwhile, since you evidently have the ear of HR, you might want to point out to her that you were uninsured for two weeks without being aware of that fact, and ask her what the company is prepared to do to help you.

[markinsalem]

CBG,

Thanks for the help, it is appreciated.

I have asked that question, and the reply was mostly "Oh well, suck's being you." paraphrased of course.

Thanks again,
Mark

[cbg]

You also might want to ask her what was the premium period. i.e. I doubt very much that the insurance carrier charged them for only 15 days at a time. This is VERY IMPORTANT - I need to know whether or not the company paid the insurance company from the first to the first, or the fifteen to the fifteenth. I am not at all sure I will be able to answer your question without this information. I am talking about on a regular basis, NOT just December.

[markinsalem]

Hello,

Sorry for the delay in responding, but I was waiting to hear from the HR representive. According to the rep, "In past months the benefit month was from the 1st to the 30th or 31st."

Thanks again

[cbg]

That's good, since it means they COULD have continued the benefits till the end of December. If they had previously run from the 15th to the 15th, my guess would have been that you were out of luck, since often an insurance carrier will ONLY terminate coverage on the last day of the benefits month, which would have meant they had no choice about there being no insurance from the 16th to the 31st. But if they ran through the calendar month, then it wasn't the carrier's forcing them to term benefits early.

I still have not determined whether or not the company is required to give you advance notice of the cancellation. However, during the mid-90's, (I don't recall the exact year but I was working for a health insurance carrier when it happened, which means it was somewhere between 1996 and 1998) Massachusetts passed a law which said that if a group health insurance policy was cancelled for non-payment, they were required to notify you within three days of the cancellation. Massachusetts was at that time, and may still be for all I know, the only state in the US with this law. This was binding on the insurance carrier, not the employer. However, it's not too difficult to extrapolate that if the MA Insurance Commission was concerned enough about people not knowing their insurance had been cancelled to set up a first-in-the-nation law about non-payment cancellations (which as often as not, and I mean that seriously, have already been reinstated before the notification got to the employees) there must be something somewhere in the M.G.L. that requires an employer to notify you when they cancel your coverage off-cycle.

I would seriously recommend that you speak with an attorney licensed in MA who is versed in insurance law. I think the odds are in your favor that your employer will have some kind of liability to you.

[markinsalem]

CBG,

Thank you very much for your help, I have contacted an attorney, and now I can at least feel like I know what I'm talking about.

Thanks again.