Wrong medical coverage selected, due to ignorance/understanding of terminology.

[acapella25]

What is the name of your state (only U.S. law)? North Carolina employer, but Georgia insured.

About 6 months ago I came to my employer, seeking medical insurance through them - my spouse lost his job and all coverage. After unsuccessfully seeking affordable coverage through Gov MArketplace (we were somehow scammed by some fake company in the process). Since I needed coverage immediately (to avoid tax fines and my family to be covered) - filled out Life Changing Event form, explaining that my family lost all coverage.

I was presented with the offered plans, and we selected one - what we truly believed was a real medical coverage. The description of the plan looked like something a medical plan offers, so we selected it and deductions from my paycheck began. I've taken my children to the doctor a few times, so routine and non-emergency situations, under the impression that we DO HAVE medical coverage. But the coverage was being declined, and bills have started to trickle in.

Fast forward to this month, I find out from the insurance company - "No, you and your family has NO medical coverage and never had it". In shock, I contacted my employer HR. They casually explain to me that what I selected is a "supplemental plan" which is not a major medical plan, but I cannot change anything until the next enrollment period (until next fall).

I am at a loss of what to do. Because of simply not understanding what I am singing up for, and truly believing I am paying for a full coverage - this left my family buried under medical bills we cannot pay. I am not permitted to correct this mistake by my employer, yet they are happy to continue taking deductions from my paycheck for something I cannot even use. I cannot afford to bring a lawyer in, because I am the sole breadwinner of the family at this time and loosing this job will basically leave my family out in the street. We will owe in taxes for not having medical coverage, and I cannot even fathom how we will manage to resolve this.

All this could have been avoided if only the HR person would just say - you are not picking the right thing. Just one line.

Is there ANY legal chance for my family to either recoup some of the money paid for this plan that we could not use? Is there ANY chance for my family to at least somehow be able to convince them to help us switch to an actual coverage. Are we basically screwed?

 

[Zigner]

What is the name of your state (only U.S. law)? North Carolina employer, but Georgia insured.

About 6 months ago I came to my employer, seeking medical insurance through them - my spouse lost his job and all coverage. After unsuccessfully seeking affordable coverage through Gov MArketplace (we were somehow scammed by some fake company in the process). Since I needed coverage immediately (to avoid tax fines and my family to be covered) - filled out Life Changing Event form, explaining that my family lost all coverage.

I was presented with the offered plans, and we selected one - what we truly believed was a real medical coverage. The description of the plan looked like something a medical plan offers, so we selected it and deductions from my paycheck began. I've taken my children to the doctor a few times, so routine and non-emergency situations, under the impression that we DO HAVE medical coverage. But the coverage was being declined, and bills have started to trickle in.

Fast forward to this month, I find out from the insurance company - "No, you and your family has NO medical coverage and never had it". In shock, I contacted my employer HR. They casually explain to me that what I selected is a "supplemental plan" which is not a major medical plan, but I cannot change anything until the next enrollment period (until next fall).

I am at a loss of what to do. Because of simply not understanding what I am singing up for, and truly believing I am paying for a full coverage - this left my family buried under medical bills we cannot pay. I am not permitted to correct this mistake by my employer, yet they are happy to continue taking deductions from my paycheck for something I cannot even use. I cannot afford to bring a lawyer in, because I am the sole breadwinner of the family at this time and loosing this job will basically leave my family out in the street. We will owe in taxes for not having medical coverage, and I cannot even fathom how we will manage to resolve this.

All this could have been avoided if only the HR person would just say - you are not picking the right thing. Just one line.

Is there ANY legal chance for my family to either recoup some of the money paid for this plan that we could not use? Is there ANY chance for my family to at least somehow be able to convince them to help us switch to an actual coverage. Are we basically screwed?

It's really not HR's job to pick your plan for you. You chose a plan and you have to pay for it. You make it sound as if "the company" is rubbing its hands together and saying "muhahaha", and that's simply not the case. The company is required, by law, to do certain things. They can't simply say "Oh, you made a mistake? Well, go ahead and change it" - that's just now how it works.

You may wish to explore buying your own insurance plan to cover you until the next open enrollment period. You should be able to buy a relatively bare bones plan and use the supplemental plan to cover whatever is not covered by your primary plan. I would suggest that you sit down with an insurance agent who is familiar with these matters and discuss your options.

 

[commentator]

There is no "bringing a lawyer in" even if you could afford to walk away from the job, because there is simply no law that has been violated, and no law in place that would require your employer to (1) fully explain and guide you through the selection of a health care plan or (2) allow you to change health care plans in the middle of a year if you decide you don't like the one you picked.

Surely, your plan that you did select and are paying for does something in terms of your health care costs. Is it a health care savings account, or just a very limited supplemental program? Will it work in conjunction with another full coverage insurance program when and if you get one?

There was a situation in this state here awhile back where these people were selling so called "health care insurance plans" deceptively, which turned out only to be medical savings accounts and provided no coverage of any kind to people, but that was determined to be fraud on the part of the insurance company.

If your company has selected the option you have as a health insurance program to offer, and it is one of the options offered, at a cost to the employee, there should be some benefits incurred from having it. You need to fully explore these with the insurance provider, not with the employer. In the meantime, I agree with the other posting, if it turns out that you are uninsured, and you need coverage until the next date when you can select another option through your employer, then you need to work with a private insurance agent or on the current, still in existence ACA programs to obtain adequate coverage.

 

[cbg]

Coming to you straight from HR, and from almost 40 years experience in Benefits.

There are, and have been for many years now (I include this because otherwise someone is sure to bring up ObamaCare - this regulation pre-dates ObamaCare by DECADES) regulations set by the IRS as to when an employee can make changes to their benefits. If the plan is covered under Section 125 of the IRS code - and virtually all employer sponsored plans are as it benefits both employer and employee for them to be - then changes can ONLY be made during the annual Open Enrollment period, or within a limited window after an IRS approved "qualified life event". Usually that window is 30 or 31 days; very occasionally it is 60. Other than that, the employer cannot legally allow you to make a change. Your HR is not being arbitrary or obstructionist or just looking to take your money - they are obeying the law.

Second, your HR CANNOT say to you, "That's not the right plan". It is not only not their job, it would be a serious overstep that in some circumstances may have legal consequences. They can answer questions if you ask them; they can provide materials about the plans; but they cannot, should not, and will not tell you what plan you should pick. They do not have knowledge of your circumstances outside of work you may or may not have; they don't know what other coverage you have access to; they can only provide you with the information about the plans THEY provide and let you make your own decision. This is not the fault of HR in any way no matter how much you would like to make it so; your employer has no legal obligation to you because you picked the wrong plan. I'm not seeing anywhere in your post that you asked anyone for help, or for explanations of how the plans worked, or anything of that kind. THAT they could have done - I do it all the time for my employees. But I cannot, and your HR cannot, tell you which plan to pick or tell you that you are making a bad choice. That is seriously outside their authority.

This sounds like I am yelling at you and I'm not. I'm sorry that you're in this situation and I wish there was an answer I could give you that would help. But your HR folk have followed the law right down the line - and trust me, if they hadn't I would tell you. I've told other posters that their HR needed to go back to HR school when the situation warranted it. But not this time; this time they did it, and are doing it, right. Unfortunately that means that you pay for the choice you made.

 

[acapella25]

I appreciate everyone taking time to read my issue and give me your opinions and facts. I certainly am not taking it personally - I understand there is no easy way to mince words. I do see that I screwed up and it's an unfortunately lesson that I will have to learn. I do thank you for suggestions on how to proceed the reasonable way.

My heartfelt thanks, this eased a lot of the stress and feeling of "I am being screwed by someone else".

 

[cbg]

If we were able to ease your mind, at least, I'm glad. I'm sorry I couldn't give what you wanted but I'm glad we were of some help at least.