Employer won't allow change of benefts after baby

[New Mom to 1]

What is the name of your state (only U.S. law)? California

Our baby was born December 3rd. Our benefits book says we have 30 days from a "qualified family status change", which includes birth of an eligible dependent.

Following are the kinds of benefits changes you
may make if you have had a qualified family
status change event, provided the change
meets the consistency requirement below:
• Add or end medical coverage​

We want to do just this, end our coverage and sign up for one (not through my fiance's work) that better meets our current needs. The plan we wish to sign up for includes the doctors I want for post-partum and other reproductive needs who are not covered under the employer-sponsored plan. We can't afford this is my fiance's company keeps deducting hundreds of dollars per paycheck.

As for the consistency requirement:

You will only be able to make changes due to
and consistent with the family status change
event. For example, if a dependent no longer
satisfies the plan’s eligibility requirements for
coverage, then you can drop coverage for that
dependent, but you can’t increase coverage of
another benefit.​

We don't want to increase coverage for anything. We want to end coverage as the plan book says we can with a qualified family status change.

This creates for us not only the problem that his employer is forcing us to continue coverage for ourselves, but since that 30-day window has passed, our daughter has no coverage of any kind. Our premiums for the two of us cost a hell of a lot more than private coverage would be for the three of us at this point. We can't afford private coverage for our daughter as long as we're being forced to continue coverage for us after her birth. The vast majority of our premium is for just me. It's less than $15 per paycheck to cover my fiance, hundreds to cover me.

I'm pretty pissed our daughter hasn't been to see a pediatrician yet because we can't afford private coverage nor the cost out of pocket because they're continuing to steal money from us by forcing us to keep coverage we do not want after our family status change. If we would have known they'd pull this, we would have put in for cancellation during the last day of last year's open enrollment which ended November 30th.

How can we get them to honor this family status change and let us end our coverage? Should be lie and say we broke up, ending our domestic partnership, so we can get me off the coverage in the meantime saving us about $600/mo so we can get me and my daughter the private coverage we want for $321/mo?

 

[FlyingRon]

How do you think ending coverage for your self meets the consistency test as mandated in the first paragraph you quote? If you wanted to add coverage for the newborn, that would be consistent. Ending coverage for yourself because you have a new born is not consistent.

Why on earth would you not get coverage for the newborn either through adding to the less desired, but allowed, current plan (and then hoping to switch when the enrollment is open) or by just doubling up on your own coverage and the plan you wanted to switch to?

 

[pattytx]

Agree with FlyingRon. The birth of a child is a qualifying event to add the child. It is not a qualifying event to drop coverage on yourself. That logic is inconsistent.

 

[ecmst12]

Private coverage for the baby only should be fairly cheap. Also you may be able to get free or inexpensive coverage through the state, CA has a pretty good medicaid/CHIP program.

 

[pattytx]

However, if this is a pre-tax medical plan through your employer, you CANNOT drop coverage on YOU until open enrollment unless there is a qualifying event. Having better coverage for your needs through another plan (such as your partner's plan through his employer) is NOT a qualifying event.

 

[nextwife]

Whatever you could do, wouldn't you have needed to notify and do this before Jan. 3, 2010? You had 30 days to ADD the baby.

You are unmarried. The baby is not legally yours unless paternity was legally established. When did that occur?

 

[CourtClerk]

You are unmarried. The baby is not legally yours unless paternity was legally established. When did that occur?

And signing the DOP would suffice, so what's your point?

 

[ecmst12]

And OP is the MOM so it's definitely her child no matter what.....

 

[New Mom to 1]

We participated in an experimental in vitro fertilization treatment to see f a new method of transferring embryos would work. The baby is definitely his, and he signed a DOC anyway. Paternity established.

When I was still in the second trimester, he verified with his bosses that this change would be allowed.

30 days from her birth is January 2nd, not the 3rd. December has 31 days. We submitted the form to drop coverage before that and didn't hear a word until after Not hearing an update we took to mean everything was fine. We only found out this week that the HR department didn't get around to it until last week. They literally have more paid holidays off than the federal government. I don't know how any company justifies 39 paid holidays off (in addition to their 2 weeks paid vacation), but they do, and because of that, no one saw our drop-form until it was too late.

I applied for our daughter for Healthy Families. I'm a stay-at-home mom with income of $0, but because her father is in the home and works, his income is counted, and is just enough to disqualify her. Because of this, I've had a couple people suggest putting her up for adoption or breaking up so that we don't live together. His company, which is one of the largest tech companies in the world, has really screwed us.

 

[pattytx]

Wait a minute. When you said "our benefit book", I was assuming you meant the company you work for. You aren't working. Having said that, the same applies to your partner as it did to you.

This. Is. Not. A. Qualifying. Event. For. Anyone. Except. The. Child.

If the child was not added within 30 days of the birth, the child cannot be added until the next open enrollment period.

 

[ecmst12]

Give your baby away or your partner away...over MONEY? Your friends give you BAD advice and I would stop asking them if I were you.

Private coverage for an infant should not be that expensive.

 

[New Mom to 1]

Patty, his employer said we could cancel when the baby was born. Now they are reneging.

ecm, we can not afford private coverage for our baby if they're going to force us to keep me covered under his plan. It's too much money, and if we pay the $256 to cover her alone under the private plan, we don't eat. You people might be rich enough that this isn't the difference between going hungry or not, but to much of America, it's not pocket change.

We decided this afternoon we're going to tell his employer we broke up. We can back this up by me having just signed a lease on a new place. A friend of mine owns it and is letting just me sign it and I can have my fiance live there without signing. So we can provide a document showing I'm moving on the 3rd. This way we can get me off his insurance and afford the private coverage.