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How could I be left out of the Group?

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Beth3

Senior Member
So what's different now that would change the reply cbg provided? We don't know how the group health Plan Document defines eligible classes of employees. Without reading that languge, it's impossible to say whether you should have been offered participation.
 
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bruwmac

Junior Member
I am eligible

Beth3 said:
So what's different now that would change the reply cbg provided? We don't know how the group health Plan Document defines eligible classes of employees. Without reading that languge, it's impossible to say whether you should have been offered participation.
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Thanks for the reply, Beth.

My reply should have gotten us past that point.

There are no class distinctions other than full vs. part time.

I am full time. I am eligible. I was eligible for and offered a policy which I didn't accept. I was considered the deciding vote for that plan to fly. They had four they needed a 5th. I said no.

They then found BC/BS. I was eligible. I wasn't offered it. It was, I am certain, an act of spite.

Now what?
 
cbg

cbg

I'm a Northern Girl
I'm not saying this to be argumentative. This is a very serious question as it relates to the key point in your question.

How do you KNOW there are no class distinctions other than full time? Have you seen the group plan document?

The fact that you were eligible for the plan you did not accept, does NOT guarantee that you are eligible for this one.
 
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Beth3

Senior Member
Having declined coverage very recently thus requiring your employer to seek an alternate carrier, I can see why they didn't offer it to you again and I very much doubt they violated any laws.

If you now wish to obtain coverage through the group plan with BCBS, you'll have to apply as a late entrant and meet any underwriting requirements they have.
 
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bruwmac

Junior Member
Beth3 said:
Having declined coverage very recently thus requiring your employer to seek an alternate carrier, I can see why they didn't offer it to you again and I very much doubt they violated any laws.

If you now wish to obtain coverage through the group plan with BCBS, you'll have to apply as a late entrant and meet any underwriting requirements they have.
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Folks - not to be argumentative either.

You seem to be missing the point.

Absolutely no information was provided on which to base acceptance. And a refusal waiver was not asked for. It just did not happen.

Even now, those that accepted BC/BS, have rec'd no information.

I believe full disclosure of details is a requirement which was denied in both instances.

Surely this matters?
 
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cbg

cbg

I'm a Northern Girl
No, you are the one who is missing the point.

You are basing your whole case on your belief, which as far as I can tell is not grounded in anything except an assumption, that the only criteria for eligibility is full time employment. That may have been the case for the plan you turned down. That does NOT guarantee that it is the case for the plan currently in place. You do not KNOW that to be the case. You ASSUME that to be the case.

And unless we KNOW what the plan document says, and yes, there is a plan document whether you've seen it or not, then no one here, not me, not Beth, not anyone else, can tell you if your employer has violated any laws or not.

Now, either find out for CERTAIN what the plan document says and come back and tell us so that we can answer your question, or take your question elsewhere. I'm not wasting any more of my time trying to explain this to you.
 
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bruwmac

Junior Member
Thank you

cbg said:
No, you are the one who is missing the point.

You are basing your whole case on your belief, which as far as I can tell is not grounded in anything except an assumption, that the only criteria for eligibility is full time employment. That may have been the case for the plan you turned down. That does NOT guarantee that it is the case for the plan currently in place. You do not KNOW that to be the case. You ASSUME that to be the case.

And unless we KNOW what the plan document says, and yes, there is a plan document whether you've seen it or not, then no one here, not me, not Beth, not anyone else, can tell you if your employer has violated any laws or not.

Now, either find out for CERTAIN what the plan document says and come back and tell us so that we can answer your question, or take your question elsewhere. I'm not wasting any more of my time trying to explain this to you.
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Thank you for your time.

Is this plan document something I could expect the Insurance Agency to provide to me upon request?

If not, it won't be forthcoming from my employer. :confused:
 
cbg

cbg

I'm a Northern Girl
Either the insurance broker or the insurance carrier should be able to supply it. You should ask for a copy of the SPD (Summary Plan Description). Do not be surprised if it takes up to 30 days to receive it, maybe even a little longer since it is a new group.
 
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bruwmac

Junior Member
Dead End

Thanks for the information

It turns out that only by written request by the owner will they send the SPD.

I am now in limbo. :confused:
 
cbg

cbg

I'm a Northern Girl
I'm sorry, but I don't know what to tell you.

Despite what it may have sounded like when I got frustrated, I'd like to help. But that information is absolutely crucial to answering your question. It's possible your employer is violating ERISA - it's just as possible that he's violating no laws at all. There is no way to tell without the SPD.

Have you even tried asking the owner if you can see it? Maybe he'd let you see it just to frustrate you.
 
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bruwmac

Junior Member
Part of the problem is the employer is out of the country for a month.

I have received no response to my email inquiries.

We will have to have a face to face discussion when he returns.

I was hoping to have some leverage ready when that transpires.

If you can point me to some online info regarding ERISA, that would be helpful. I had located some very brief information on ERISA and rights to benefits prior to posting my question. Any links you can provide to more comprehensive resources would be appreciated.

Thanks again for your time and interest.
 
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Beth3

Senior Member
bruwmac, at this point I'd advise you to contact the federal Department of Labor and see what they advise. You're between a rock and a hard place - you can't determine whether the employer has violated the law until you can review the SPD and you can't get hold of a copy. As a non-participant, I don't believe you can demand a copy from the employer either.

I'm sure you're not the first person to find yourself in this predicament and I expect the DOL can advise you.
 
cbg

cbg

I'm a Northern Girl
ERISA is an enormously long and complicated law. I know the general provisions, and my best friend is so expert at it that ERISA attorneys at the law firm where she works come down to consult with her - she's not an attorney, she's in HR, and she works for one of the 10 best rated law firms in the US. But with the limited information available to us, I wouldn't even know where to start pointing you. I agree with Beth - see what the DOL can tell you.
 
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