pregnant and uninsured

[lisanogie]

What is the name of your state? California

My sister was on the Cal Cobra plan from her husbands old work. She has paid her premiums and recently had various prenatal visits and tests. Unbeknownst to her, his work changed plans and she was not informed. Cobra has dropped her and reimbursed her last 3 months of premiums. She is 16 weeks pregnant and now cannot find insurance coverage because they are considering her condition pre-existing. Is anyone liable for not informing her she would no longer have insurance coverage and/or what can she do?

[JETX]

Originally Posted by lisanogie

Is anyone liable for not informing her she would no longer have insurance coverage and/or what can she do?

Yep. Her husband is liable to her.... why didn't he tell her about the plan change?? There is NO obligation for an employer to contact an employees spouse and tell him/her about a change in insurance!!

[mlane58]

Under the Cal COBRA plan;

Termination of Continuation Coverage
Termination of continuation coverage may occur in the following cases:

Premium non-payment.

Termination by the employer of all its group health plans. [In case of a plan termination, the Insurer must send notice of termination and individual conversion information to the continuee no later than 180 days prior to end date of coverage. In addition, the employer must notify the qualified beneficiary at least 30 days prior. If the policy is being replaced, the qualified beneficiary may elect to continue under the replacement policy within 30 days of the notice.]

Failure of the qualified beneficiary to notify or make elections in a timely manner.

Qualified beneficiary is covered (not just eligible) under another group health plan, unless the new plan includes pre-existing condition limitations pertaining to the qualified beneficiary's condition.

Medicare entitlement.

So JET is right that the employer is not obligated, but the isurance carrier is.

[lisanogie]

To clarify the situation: The previous employer (where the Cobra plan derived from) failed to notify her and her husband 30 days prior to switching insurance plans; thus never allowing her to select a different plan. The switch was made Jan 01 and now the broker is telling her it's too late (past the 30 day window) and she will not be able to find a carrier. It seems like the employer should be liable in this mess also.

[mlane58]

No the employer is not obligated, she needs to contact the California Department of Insurance and file a complaint.

[JETX]

Originally Posted by mlane58

So JET is right that the employer is not obligated, but the isurance carrier is.

Sorry, but the latter part of your sentence is NOT true. READ the post. The employer didn't cancel the insurance.... but changed plans.

[ecmst12]

But by the way, it is ILLEGAL for any insurance plan to consider pregnancy a pre-existing condition....

[cbg]

Not quite accurate. It is illegal for an employer-sponsored group health insurance policy to consider pregnancy a pre-existing condition. No such restriction exists for individual policies.

[AHA]

Originally Posted by ecmst12

But by the way, it is ILLEGAL for any insurance plan to consider pregnancy a pre-existing condition....

It is still a known fact that no insurance company will want to touch you, even with a ten foot pole, if you are already pregnant. A pregnant woman is pretty much uninsurable.

[Sugarbaby1977]

The only insurance she might be able to get being pregnant is medicaid and that's only if she falls within the income brackets.