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Disability and health insurance

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  • Disability and health insurance

    I`m a Breast Cancer patient on Short Term Disability. I have been on disability since May1, 2008. I live and work in Lafayette, Indiana. I have just received a call from my employer regarding my health insurance. Human Resources told me due to only working 6 months at their place of employment and not being eligible for FMLA and not currently actively working my health insurance could be terminated by Anthem Blue Cross Blue Shield, especially if they get audited and provide this information. I need my health insurance to continue my treatment and to be able to get my surgery. How true is this, and is there anything I may do so this does not happen?

  • #2
    Most policies have some kind of limit on them. Ours here allows us to keep employees on the policy for only 90 days after they cease active work. We just had to put an employee on COBRA due to a Worker's Comp injury since he had been out over 90 days.

    It may not be up to the company but rather insurer's regulations. And yes, keeping someone who is not eligible on the policy can create major problems for the employer. Its called fraud.
    I find that the harder I work, the more luck I seem to have.
    Thomas Jefferson

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    • #3
      I guess it depends on the definition. Ours does not allow us to insure anyone who is not <actively working> (their definition) beyond 90 days. So we can not keep anyone on the plan who is on the books but not working.
      I find that the harder I work, the more luck I seem to have.
      Thomas Jefferson

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      • #4
        You should be offered COBRA which will allow you to remain insured as you are now so long as you pay the cost of the premium. There may be an additional 2% added to the cost as an administrative fee.

        Clocking them in just for the purposes of keeping the insurance going would also be considered fraud. Insurance companies take a very dim view of this. They base their rates on a certain level of risk and set the reserves based on this. Covering folks indefinitely who are out for extended periods messes with this big time and is just begging for the IC to sue for fraud/ breech of contract.
        I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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        • #5
          Have you ever administered an insurance plan?
          I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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          • #6
            I read this thread but had nothing to add.

            I never administered an ins. plan. I had several jobs at an ins. co. - the one I had the longest & most recent was underwriting ins. applications. I took many exams (one included some info on the administration of ins. plans) to get professional designations but that is as far as it goes.
            Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around. Leo Buscaglia

            Live in peace with animals. Animals bring love to our hearts and warmth to our souls.

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            • #7
              I have administered health plans. Several of them. This would not fly. There is a reason they put those types of clauses in their plans.
              I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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              • #8
                Why you are so concerned about when and how I get my work don't I will never understand. My employer doesn't have an issue, why should you?
                I post with the full knowledge and support of my employer, though the opinions rendered are my own and not necessarily representative of their position. In other words, I'm a free agent.

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                • #9
                  Anyone who has an issue with another poster's credentials - take it up with them off line. This is not helping the poster.
                  The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

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                  • #10
                    Joec, it is insurance fraud to do as you say. We have been audited by our insurance carrier and when they found someone who had not worked the minimum number of hours required for coverage (avg of 30+ hours per week under our plan) over the past 90 days they immediately canceled that person's coverage and put us on notice that if it happens again they will cancel our plan.

                    The OP has a right to coverage. It's called COBRA. While it's expensive, it will be a lot cheaper than the cost of treatment I'm sure.

                    Comment


                    • #11
                      Originally posted by joec
                      Then put in 30 hours in 90 days. Keep em covered.
                      JoeC
                      Joe, unless the person is working 30 hours per week (or whatever the magic number is for that particular policy) it is insurance fraud. The employee can pick up COBRA coverage. If the company wants to they can pay for the COBRA coverage (though if they do for one they will be asked to do for others) but the person can not be continued as an active employee. Doing as you suggest jeopardizes the health plan for all employees and will make it difficult for the employer to find group coverage in the future.

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                      • #12
                        Originally posted by joec
                        Likewise the o.p supervisors have the same discretion in what they are classifying as work.
                        JoeC
                        Sure, of course. But then the employer needs to PAY for those 30 hours of "work". If that's being done, then the employee is working and meeting the minimums. That's not a problem at all. But I don't know many companies that would willingly do that if "work" was not performed. The insurance carriers will specifically look at labor/timekeeping, and payroll records. They won't take an employer's word that so-and-so is working 30+ hours. They want to see it in official records.

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                        • #13
                          Joe, I don't know why you have such a thorn in your side over Elle posting during the business day when so many other posters here do the same thing, but the on line comments about it are to cease immediately. If her supervisor isn't worried about it there is no need for you to be.

                          The bottom line for this post is that if the employee does not qualify for benefits any longer, it would be fraud for the employer to say that she does.
                          The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

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                          • #14
                            There is a difference between catching a couple of minutes here and there during a break or while on hold, and declaring an employee to be eligible for a benefit when they are not.
                            The above answer, whatever it is, assumes that no legally binding and enforceable contract or CBA says otherwise. If it does, then the terms of the contract or CBA apply.

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                            • #15
                              Is any of this helping the OP?
                              Maybe some of this should go to PMs.??
                              I find that the harder I work, the more luck I seem to have.
                              Thomas Jefferson

                              Comment

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