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alee

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

Okay, I'll try to make a long story short.

My husband left his job when it had been 4 weeks since he recieved a paycheck. Right after he left I called the insurance company to be sure we maintained coverage since I was 8 months pregnant and I have a toddler. They told me the coverage would probably go to the end of the month (June) and to call back. July 1 I called and the insurance had been terminated. I requested the conversion (like COBRA) paperwork. I finally got it 2 weeks after my son was born (4 weeks after I requested it). In the middle of August, 2 weeks after I sent them my paperwork and the first months premium they sent it all back saying that I had not had coverage for 90 concecutive days because my husbands boss wasn't paying the premium. He had only paid for one month of coverage. The first month. Now we find out, in mid-August, that we haven't had coverage since April 1 and now we had about 12k in medical bills.

So, here are my questions: :confused:

1. What are we entitled to? Does he just owe us what he took out of my husbands checks or does he owe us what the insurance would have covered (80% after a $500 deductable was satisfied)?

2. We have contacted the DOL and they are investigating. If we settle with my husbands old boss and he actually gives us an amount that satisfies us will that stop the DOL from investigating? He did break the law. He did this to 2 other employees too. While they never used their insurance he does owe them a total of about $8-10k. At least my husband got all but $700 of the pay he was owed (He got it 6 weeks after he left the company). We're still not even sure if he has been paying his taxes with the money he took out of the checks.

3. Can he go to jail for this?

4. I was able to get Medicaid for my hospital bills and one Dr. bill. If we do reach an agreement with this weasel do we have to give the money to Medicaid? Do I pay myself back for the bills I paid out of pocket and then send the rest to Medicaid? Do I just keep it all as compensation for nearly 6 months of hell this man put us through? The Medicaid lady did tell me that if we take him to court and there is a judgement I need to be sure to make sure they know that Medicaid is the insurance company that needs to be reimbursed. But if we just settle outside of court (for probably 1/4 of what we should get and 1/8 of what we would get if we went to court) what then?

5. Is there anything else we should be doing? I'm worried that even if we take him to court and he gets a judgement and all that we still won't ever see a dime and I'll be out more money than when we started.

Thank you in advance for your advice. Sorry so long! ;)
 


cbg

I'm a Northern Girl
Alee, I can't answer all your questions. But since no one else is stepping up to the plate, either, I'll do the best I can with the ones I can.

1. As far as I know, legally he owes you only what was deducted from your husband's check. You are free to check with your state insurance commissioners office to see if any state or local mandates require that he pay the amount the insurance would have paid.

2.) That is far too situation specific to answer. But in my experience, the DOL doesn't stop investigating until they are convinced they've weeded out any and all violations. You would have to withdraw your complaint for them to stop, and even then, if they're finding a number of violations, they may not.

3.) On the basis of what you've said, I very much doubt it. Maybe if the DOL finds more violations. But just because this isn't a jailable offense doesn't mean he'll get off scot-free. He can and most likely will be heavily fined.

4.) Sorry, this is something I can't answer. No idea.

5.) Nothing I can think of off the top of my head. If you want to, you can consult with an attorney (many give free or low cost consultations) in case there are any details you've inadvertantly left out or I am missing.

BTW, and I have a lot of experience with group health insurance plans from the HR, the insurance carrier, AND the third party administrator sides of the desk (not to mention as an employee myself), I think it VERY unlikely that the insurance on your husband only was terminated. It sounds to me (and the dates you give support this) that the entire policy was cancelled for non-payment, and that (as is quite, quite common) the cancellation was retroactive.

The other thing to remember is that in 49 out of 50 states, health insurance is an OPTIONAL benefit. No law requires that an employer provide health insurance AT ALL, except for certain-sized employers in the state of Hawaii.

That doesn't mean that he gets off with no penalties. If he chooses to provide insurance he has to follow both state and Federal laws regarding it. But it does mean that it's unlikely that he will be required to reinstate the insurance.
 
A

alee

Guest
cbg said:
It sounds to me (and the dates you give support this) that the entire policy was cancelled for non-payment, and that (as is quite, quite common) the cancellation was retroactive.

The other thing to remember is that in 49 out of 50 states, health insurance is an OPTIONAL benefit. No law requires that an employer provide health insurance AT ALL, except for certain-sized employers in the state of Hawaii.

That doesn't mean that he gets off with no penalties. If he chooses to provide insurance he has to follow both state and Federal laws regarding it. But it does mean that it's unlikely that he will be required to reinstate the insurance.
CBG:

Thanks so much for responding. I appreciate it.

Indeed the whole policy was canceled and they told us that he went so long without paying that they would not even take his money to make things right again. Though his employer took money out of my husband's checks in the months of February, March, April and May we ended up only having coverage for the month of March. The money he took out of his checks in March, April and May has just dissapeared. The insurance company may not take his money but we sure will!

In our state employers are required to make available insurance to full time employees. That doesn't meen they have to pay any of it and it doesn't mean it will be a group plan, it just means that if the employee has been with the company a certain amount of time and is full-time the employer has to make it available. In this case, my husband has an employment contract stating that he will have insurance coverage for his family. Since his boss agreed to provide this insurance and since he took out the money from his checks he has a fiduciary responisbility...does he not?

As of yesterday we have insurance with my husbands new job. I don't want the other insurance reinstated I just want back what he took from us. 1 week of pay and 3 months of insurance premiums. It makes me sick that someone could do this to someone else. What cracks me up though is that my husband's ex-co-worker says he is still trying to make a go of his business (he really has to) and the one person he really needs to help make it happen is my husband. I guess he screwed the wrong guy.

Thanks again for your help. I was honestly nervous posting on here with the way some people respond to the posters. You were very nice and very helpful and I appreciate that. :)

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cbg

I'm a Northern Girl
"In our state employers are required to make available insurance to full time employees. "

That's news to me. I'm not saying you're wrong; the law could have changed since I last looked. But have you got a link to something supporting that statement, for my future responses?l
 
Just Curious

I totally agree with everything cbg said to you...and I know her to be well-versed in both group insurance and state law issues. I trust everythign she told you as the truth.

That being said, I am curious as to why you believe it is a law in your state (Indiana...which as you can see is also my state) that all employers must offer insurance to full-time employees. I am telling you that is absolutely NOT true. As cbg stated, no employer in any state (except certain employers in Hawaii as she mentioned) has to offer insurance of any type to any employee. Can you cite a specific law for us? I am curious and I am sure cbg is, too! :)
 
A

alee

Guest
SuzieWahoozie said:
That being said, I am curious as to why you believe it is a law in your state (Indiana...which as you can see is also my state) that all employers must offer insurance to full-time employees. I am telling you that is absolutely NOT true. As cbg stated, no employer in any state (except certain employers in Hawaii as she mentioned) has to offer insurance of any type to any employee. Can you cite a specific law for us? I am curious and I am sure cbg is, too! :)
I actually don't have anything to back up my statement. :eek: When I got my first job I worked part-time and when I, my husband and my husband's friend switched to full-time my boss told me he had to offer me insurance. He said the company wouldn't pay any of it but that they had to offer it to full-time employees. That they had to make it available. At my other jobs I was either contract or part-time so I never knew any different. My husband also claimed it to be so and since he always had insurance, even if though sometimes it wasn't covered by the employer at all, I assumed it was true. It always sounded weird that the state could mandate such a thing but maybe we just got confused with our first jobs. Maybe he meant that he had to because it was a corporate policy rather than a law. Is there a link you could give me that supports your statement that it is absolutely not a law? I don't doubt you, I would just like to show my husband since this has actually been an ongoing argument for the last 9 years! I guess I gave in too soon.

Thanks again.

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Beth3

Senior Member
alee, the reason your former boss told you he had to offer you insurance when you went from part-time to full-time was because per the terms of their group health contract, all full-time employees were eligible to participate in the benefit plan. Your employer was complying with the terms of their insurance contract/Plan Document as is required, not with any State laws.

Had your employer stated in their insurance Plan Doc that only left-handed employees with red hair are eligible to participate in the group health plan, then that's the group of employees the company would have to offer insurance to - everyone else would be excluded from participation. (Yes, it's a silly example and no insurance carrier would underwrite a policy like that but you get the idea.)
 

cbg

I'm a Northern Girl
Alee, what I can offer you is negative evidence. Nowhere on the Indiana state website does it say that all full time employees must be offered access to insurance. If that were indeed a law, it would be out there with all the other laws employers are required to follow.

Don't know if that will prove your point, or not. :)
 
A

alee

Guest
Thanks everyone for your help and clarification. It does make sense to me.

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