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Who's Right? Not sure I'm covered!

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vregan

Guest
What is the name of your state?What is the name of your state?Michigan

I applied for health care benefits via my employer (Tyco-ADT) back when I was eligible, after being hired in August 2004. Payroll deductions for my contribution to the health care benefits began in late September and continue with each weekly check.

I've never received a health coverage card from the insurer, which is Blue Crosss/Blue Shield. My benefits department had me call them in the past and they do not have me in their system. The benefits department went to work on looking into it for the last two months or so, but as of last week I am still not in the Blue Cross/Blue Shield files.

I am maintaining I may not be legally covered, but my employer says that I am covered should I need care and that the employer can verify that for any health care professional needing to know--that I just need to have them call my employer until they can get this three month old mystery solved and get me a Blue Cross/Blue Shield card.

Am I legally covered should something happen today to myself or my kids?
 


cbg

I'm a Northern Girl
Yes, you are. You have been paying for the coverage and your employer, who owns the policy, will verify that it is their intent for you to be covered and that you meet the eligibility criteria.

Coverage does not begin on the day you receive the insurance card. Coverage goes into effect on the day your employer tells the insurance carrier is the first day of coverage.
 
V

vregan

Guest
cbg said:
Coverage does not begin on the day you receive the insurance card. Coverage goes into effect on the day your employer tells the insurance carrier is the first day of coverage.
Thanks. My concern is less the cards, and more that the insurance carrier doesn't have me in their system--so, from their perspective, I fear--in light of three months passing--they may maintain that the employer hasn't told them I'm covered.

Would it be appropriate to get something in writing from my employer that states they notified Blue Cross/Blue Shield on "such and such" day and my coverage was effective as of that date?
 

cbg

I'm a Northern Girl
If it will make you feel better, then ask your employer for such a letter. But speaking as one with 25 years worth of experience administering group health insurance plans, I honestly don't think it's necessary until or unless you actually have a claim. Also, providing you with a letter guaranteeing your coverage is not going to be on your employer's radar as a high priority.

BCBS can CLAIM anything they want - I assure you, your employer has proof that they did so notify them. Besides, I've worked with BCBS and at least in my state, they're not in the habit of telling their clients that the client didn't do something, when the client says they did.

BTW, don't misunderstand me. If your employer notifies BCBC on August 25 that your coverage is effective September 1, it's effective September 1, not August 25.
 

Beth3

Senior Member
vregan, it sounds like BC/BS eligibilty department may have mislaid your enrollment paperwork. (Those are the people who handle adds and cancels and the associated data entry and it's a completely separate group from those who pay the claims.)

I agree with cbg that if your employer notified them of your enrollment and has been paying your premiums, you're "covered" regardless of any administrtive SNAFU but when and if you do have a claim, payment is going to be delayed while it all gets sorted out.

Since it's been three months and they still haven't mailed you your ID cards, it's more than reasonable to assume they simply never entered you into their system. Since your own benefits department has been looking into this for two months with no apparent success, I suggest you contact your Benefits Manager. This just isn't that difficult to fix. Frustrating yes; difficult no. A couple of phone calls and perhaps re-faxing your enrollment paperwork should do the trick - hopefully.
 

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