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  • Cancelled health insurance

    I'm not sure if this is the right place to ask this question but please bear with me....
    I live and work in virginia and am an exempt employee.
    My employer provides health insurance for which we pay @$50 per month. I went to the doctor shortly after starting this job and then not again for about a year. When I tried to go back I was told by the insurance company (Kaiser) that my insurance had been cancelled for non-payment of 1 months premium a year earlier. I then spent 2 months trying to get it straightened out, during which time I paid my own medical bills, and thought I had.
    At some point my employer changed insurance companys but kept me on with the old one because I had a pre-existing condition which kept the new company from insuring me. (a 15 year old condition covered by Workers Comp). At this point the insurance converted to my own policy, still paid for however by the company, which continued to deduct payments from my wages.
    Six months later I tried to go to the doctor and again was told by Kaiser that my insurance had been cancelled, still because of the same missed payment.
    During this time (over 2 years) both my employer and I had continued to make payments.
    After more wrangling with the insurance company the insurance company said they would not reinstated my insurance but were going to refund the money they had collected. As far as I knew this had not been done.
    About 6 months ago the business was sold to a new owner but I have remained in contact with the previous owner.
    I just found out that they have returned a large sum of money to my employer. However none was returned to me, my insurance was not restored, nor was any of my medical bills paid.
    So finally, here is my question: Am I entitled to receive some of the money returned to my ex-employer?
    Thanks for listening to this long winded question!

  • #2
    You are entitled to receive back any money that you personally paid towards the insurance.
    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.

    Comment


    • #3
      There are several different pieces of advice that I have for you, but first, how long had you been insured before the employer changed to the new insurance company?

      Were you previously insured with another job?


      Were there any breaks in coverage when you changed jobs, and if so, for how long?

      Comment


      • #4
        To answer Bears questions:
        I was insured for about 9 months with Kaiser under the group plan. When the employer changed company's I continued with Kaiser under an individual plan but paid by my employer for almost 2 years. (BTW the missed payment was after I was converted to an individual plan.)

        Yes I was covered by another jobs insurance but there was a break of about a year.

        Since there was no employment contract I guess the employer would not be responsible for any of my bills. (Although the fact that he had been paying the insurance would seem like an implied contract) Is this correct?

        Thanks again!

        Comment


        • #5
          Okay. My last question is were you informed, and did you consent to being on a different insurance than everyone else in the group, and were you specifically told that your policy was being converted to an individual policy prior to its conversion?

          Comment


          • #6
            Yes, I knew I was going to remain with Kaiser on an individual account when he changed carriers. As I said in my earlier post, the new carrier would not take me because of my pre-existing condition. The reason my employer changed carriers was to save money. After conversion my individual policy was costing him $500 per month as opposed to @200-250 for each individual with the new policy. (Kaiser offers a standard conversion rate for anyone who at the time an employer cancels a policy wishes to continue with them).

            If you have any more questions I would be more than happy to answer them; I appreciate the time everyone spends answering mine as well as everybody else's posts!

            Comment


            • #7
              Originally posted by andreasarrah
              Yes, I knew I was going to remain with Kaiser on an individual account when he changed carriers. As I said in my earlier post, the new carrier would not take me because of my pre-existing condition. The reason my employer changed carriers was to save money. After conversion my individual policy was costing him $500 per month as opposed to @200-250 for each individual with the new policy. (Kaiser offers a standard conversion rate for anyone who at the time an employer cancels a policy wishes to continue with them).

              If you have any more questions I would be more than happy to answer them; I appreciate the time everyone spends answering mine as well as everybody else's posts!
              What I suggest that you do is talk with either the insurance commissioner of your state and an attorney. It is a violation of federal law to offer coverage to a group, but decline to cover an individual within that group because of medical history. The new insurance carrier didn't want to take you because they knew that within the plan year that they would be legally obligated to cover all pre-existing illnesses. I would be willing to bet my britches that the new insurer told your employer that if this one particular person were not insured with us, then it would drop the rates on everyone else. So, your employer just told you that the new insurance wouldn't take you. Without knowing the consequences of such, you agreed. The problem is that by being switched to an individual policy instead of continuing with the group, you lost some of your legal rights under HIPAA and COBRA law. I suspect that you consenting to this change will be a hurdle for you to overcome, just a small one though. I am 99% certain that you cannot waive your legal right to COBRA and HIPPA in that manner.

              As far as the cancellation goes, since it was an individual policy, they would have certainly had legal obligation to notify the policy holder of the cancellation. Most states provide for a 30 day notice of cancellation. If your policy was an individual policy that your employer was paying, my guess is that the bill went directly to the employer...AS WOULD THE CANCELLATION FOR NON-PAYMENT OF PREMIUM NOTICE. Your employer likely ignored it, which resulted in the cancellation of the policy.

              You are certainly entitled to a refund of the premiums that you have been paying since. How you go about getting those premiums back, and how you should handle this going forward is going to depend upon what happened in the sell of the business. If the company filed bankruptcy, and the old company simply sold the assets to the new one, then you would have to go after whomever received the check from the insurance company. If ownership of the company was transferred, debts and assets included, then you would need to pursue your current employer.

              If you can tell me what happened to company that was sold, I can advise you further.

              Comment


              • #8
                The company did not go bankrupt. It was a restaurant franchise (Chesapeake Bagel Bakery) however the ownership transfer ended up being kinda weird. As far as I know the new owners never actually took "possesion" of the franchise just the physical store because the entire franchise is being closed down.
                The owner, who up till now I maintained a good relationship said in an email to me:

                "We are in a new year, the 2005 finances are closed, the company is closed. I did get some money refunded from Kaiser. I was rather surprised when it finally came, long after I thought that you'd straightened things out with them...
                I didn't receive a refund til months after I was told it would come to me, which is why I was surprised when it came. By then I was not going to waste any more time on the issue. End of subject.

                This is all I know.

                BTW, I no longer work for the new owners, I stayed for a few months to help with the transfer and now have a new job.

                Thanks again
                Last edited by andreasarrah; 01-18-2006, 10:35 AM. Reason: remove smile

                Comment

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