Health Insurance coverage cancelled without notice

[Inann]

What is the name of your state?What is the name of your state? MO

My husband works for a small company that provided health insurance for he and his family (myself and two children). They've been habitually paying the premiums late, so often claims would have to be re-sent through. I spoke with the insurance company last nov, they said my insurance would never be canceled because of late payment by the employer. Well, it appears that the status on our coverage is now showing as terminated. It appears to be effective back to June 1st, so about two months worth of claims. My husband is going to check with his employer to see if it was intentionally cancelled or just two months past due. My question is, what recourse, if any, do we have if they have cancelled our insurance coverage without any notice? (I think they may be too small for us to qualify for COBRA) I have a significant medical history, and was actually still in an 18 month pre-existing period (ending the end of this month). I am concerned for what this may do to my insurability having a lapse in coverage, etc?? Not to mention claims submitted in the past two months.

Thank you for your help!

 

[cbg]

Since COBRA is a continuation of existing coverage, if the plan is cancelled there is nothing to continue. So COBRA is out regardless of how many employees they have.

I am assuming from the fact that you had an 18 month pre-ex to work off, that you did not join the plan at your first opportunity. 18 months is the time period for late enrollees. What was your insurance history prior to this?

 

[Inann]

I had group coverage at a previous job that was cancelled retro active after a leave of absense from which I didn't return to work. I was to be covered by my husband's insurance, but they decided when they went to start his insurance that it was going to cost too much to cover all of us (my husband, myself and our daughter) living out of state, so my daughter's and my coverage did not start until we relocated to MO. Then when we got moved, they said we had to wait until his annual enrollment date, so we had to wait another 4 months for us to be added. So due to both of those issues, I was uninsured for about a year and a half before my coverage finally started here.

 

[cbg]

Okay, that helps.

Unfortunately, there isn't a lot of good news. IF it was an intentional cancellation you won't have much choice but to look for individual coverage, and they MAY (I don't say will) choose to include a pre-ex clause since individual plans are generally not covered under HIPAA laws. You MAY be able to hold the employer responsible for any bills up to the time of cancellation since you were not given any notice, but you will want to talk to the state Insurance Commission about that.

If it was unintentional but the insurance carrier refuses to reinstate because they've been late so often, your recourse may depend on what the employer does. If he plans to pick up a new plan, you may be okay. If there is a gap between the two plans, you might want to pick up a short term policy and I don't think it would be unreasonable of you to expect your employer to pay at least part of it. Whether you can legally demand it of him will depend on your state's law, and again, for that you will talk to the state Insurance Commission.

If it was unintentional and the plan is reinstated, you should have no problems.

After your husband talks to the employer, come back and tell me what he said. I MIGHT (I can't promise) have some more suggestions after that.