Legal Advise on Medical Insurance ?

[bollin99]

Hello.

I am working for a NY based company for a while and I live in NJ. But I have not been provided Medical Insurance until now. My health administrator says that it's activated. But I did not get the medical card until now .So the health administrator told me to coordinate with Insurance Agent( Biggest dumbo on earth) who is not activating the insurance. I called the Insurance Company to check whether my account is activated. But they say it's not even in the pendig list.So I am just living without health insurance. My Lasiest health administrator is just not bothered regarding this issue.

I do not have any employee contract with the company. It's just a verbal understanding regarding providing medical insurance. I am also single and have no alternative but to go with the company's medical insrance policy.

1.Can my company be responsible incase somethig happens to me during this period ?
2.Can I proceed legally against them for not providing me insurance
3.Can i do the same with the Insurance agent of the company.

Please Advise me regarding this.
Thankyou

 

[cbg]

Are you an employee of this company? An independent contractor? A vendor? What is your relationship with them? It makes a BIG difference to the answer.

 

[bollin99]

Medical Insurance

I am employee of the company and have been on their payroll for the past 6 months. I am sure there will be a difference between a contractor and an employee.
But need info regarding the questions placed in the previous thread.

Thankyou

 

[cbg]

I know you want yes-no answers to your questions, but it isn't that simple. For one thing, there is NO legal requirement at the Federal level or in any state except Hawaii which requires an employer to provide you with health insurance. It's going to depend upon whether or not the employer has contracted with his employees to provide health insurance and if so, whether or not you fall within the confines of that contract.

Are you the only employee in New Jersey? What does your employee handbook say about health insurance? Does it say that ALL employees will be offered it, or does it specify certain classes of employees? (all employees working more than 30 hours a week, all full time employees, all management employees, that kind of thing) Does it say anything about a waiting period?

Did you complete an enrollment form? Did you turn it in to the employer? Did you do so within the time frames established by the company/carrier?

I'm not trying to give you a hard time. You're asking questions that are EXTREMELY fact specific, and I cannot answer them without this information.

 

[lkc15507]

Agree with cgb. But, just to help clarify, if you are an employee (by definition), and the employer does offer a group health insurance plan, then you DO likely have a contract with them regarding health insurance. If others in the same / similar capacity as yourself are covered, then you should be as well. An employer cannot offer health insurance to one an exclude another that is working in the same capacity. Ask for, and then read the plan document booklet. This will define how, when, if, you qualify; if you qualify according to the terms of the plan document (again if the employer has an insurance plan at all) then, the employer is bound by that contract.
lkc15507

 

[cbg]

lkc - Although you are correct in everything you say, I think there's more than a reasonable chance that our poster is going to find that similarly situated employees are NOT covered. The clue here is that in his initial post, he mentioned a "verbal agreement". It wouldn't be the first time some well-meaning manager agreed to provide a benefit to an incoming, ineligible employee, and learned only after the fact that it was contractually impossible. This would also explain why there's not even a pending application showing.

Of course, it's also possible that he is entitled to coverage and it's all an administrative error. But there are subtle clues to indicate that's not going to be the case here.

 

[bollin99]

MY company is based in NY, but I live in NJ and work for client in NJ. I also work 40hr/week.
Also I have completed the Insurance enrollment form 4months back and neither the administrator nor the Insurance agent are taking interest in activating even after numerous calls and reminders.

And the most unfortunate thing is that I never signed the employee contract nor do I have an employee manual for reference. But I am pretty sure that they provide insurance to all their employees .

Thankyou

 

[cbg]

"Pretty sure" isn't going to cut it. You need to get your hands on the employee manual or the SPD of the insurance contract to determine whether or not you are eligible for insurance.

Until we know that for sure, any information we could give you on your legal rights is going to be nothing more than a guess.

 

[lkc15507]

cbg,

Point well taken. I did overlook the "verbal agreement" in that statement. What you point out does seem possible.

lkc15507