Health Insurance eligiblity

[fd0331]

What is the name of your state? New York

I I just found out that I had become eligible for my employers group health plan effective 12/1. However, since i hadn't been notified, I already paid a COBRA premium for the month of December. I have been told by the COBRA company that they cannot remove me from the plan retroactively, so I am stuck with the $150 payment I made to them. My question is - is there a legal obligation for my current employer to notify me upon becoming eligible for their plan? Is there any recorse for me since because of their failure to notify me, as I am now stuck paying both $150 for December COBRA coverage and $45 for december group coverage with my current employer (which is required, since if I do not enroll in December, my window of eligiblity passes and I have to wait another year).

 

[cbg]

Yes, there is an certain obligation for them to tell you about eligibility. However, that does not mean that someone has to take you by the hand, look you in the eye, and say, "You will be eligible for insurance coverage on December 1. Here is what to do about it". If you look at all the paperwork they gave you on the first day of employment, there will no doubt be something in there telling you how eligibility is figured, if not precisely when your coverage will begin. That is considered notification; you are responsible for reading the information they give you. And if there is nothing there, it does not behoove you to wait for someone to tell you; instead you need to pick up the phone, call your manager or your HR person, and ask them when coverage will begin. While they have responsibility for notification, you also have a certain amount of responsibility to ask. If your plan is covered under Section 125 (if your portion of the premiums is taken out pre-tax, or if you have the option to do so, it is) then there are Federal restrictions on when you can join the plan. It doesn't pay to simply wait for someone to tell you - you need to be pro-active.

I'm sorry if this sounds harsh. It's not intended to. But too many people these days are opting out of their own responsibilities and then wanting to sue when things don't go the way they want. Since you did find out about your eligibility in time, I doubt if you can take legal recourse. There's no reason you can't ask if your company will reimburse you for the COBRA payment under the circumstances, but they are not legally obligated to do so and I'd think carefully about the way I asked the question if you decide to do so.

 

[fd0331]

Thank you

Thanks for your response. I did receive 'notification' in the typical employee handbook when first hired. The only reason I wasn't on top of this in the first place was my original staus was hourly (with a three month waiting period), but soon after I was moved to management (with immediate eligibility). I had disregarded the 'immediate eligibility' at the time because it hadn't applied. I only discovered this when re-reading the manual to see if I should pay my January COBRA premium. Its been a while since school, and I couldn't recall or find reference to whether the requirement was to give notification UPON eligibility or just as to when an employee WOULD become eligible in the future. (and as a side note, because of this same situation I now find I should have been credited two days vacation time over month ago, but I now have a week to use it or loose it!). Talk about falling between the cracks! Thanks for your assistance.

 

[CIAA]

fd0331,

You'll have to check your policy, but I believe that COBRA coverage automatically cancels or terminates once you obtain other coverage. That being the case, your written notification to cancel would not be required and it seems that you would be entitled to a refund.

 

[cbg]

To the best of my knowledge, COBRA does not automatically term when other coverage is obtained. I believe that was intended to be the case initially, but then the question arose about issues when the old coverage covered something necessary that the new coverage didn't.

Besides, how would the COBRA carrier know that the insured had obtained new coverage?

 

[CIAA]

From the Dept. Of Labor Website:

Coverage begins on the date that coverage would otherwise have been lost by reason of a qualifying event and will end at the end of the maximum period. It may end earlier if:

Premiums are not paid on a timely basis

The employer ceases to maintain any group health plan

After the COBRA election, coverage is obtained with another employer group health plan that does not contain any exclusion or limitation with respect
to any pre-existing condition of such beneficiary. However, if other group health coverage is obtained prior to the COBRA election, COBRA coverage may not be discontinued, even if the other coverage continues after the COBRA election.

 

[cbg]

Okay, that last paragraph is probably what I'm thinking of, only I got it backwards.

I still want to know how the COBRA carrier is going to know about the other coverage if no one tells them.

 

[CIAA]

Well, this same question can be asked of any situation where someone takes out multiple coverages.

If any coverage is used or assigned to the hospital/provider this will be shown. If you show employment, it too will be in the record. Finally, the claim forms to be completed ask you and your provider to disclose any other plans.