Semi-CEP: Employer Health Insurance problem

[smock]

I have a question for the CEP hive mind, related to employer-provided health insurance, everyone's favorite topic. Mr. Smock got a new job in November, and was told by the company that he qualified for benefits as of Jan. 1. On their word, we canceled our previous coverage (through the exchange). Then the company told us on 12/20 that his benefits eligibility doesn't actually start until Feb. 1. 

So . . . now our entire family is uninsured because of an HR fuck up. The company has admitted the fuck up and the local boss promised (in writing) to either provide insurance OR pay for a private policy for the month of January since it was their fuck up. But apparently an HR error isn't a qualifying event and by the time the company notified us, it was past the enrollment date for private insurance. (We ended up on long phone calls with a half dozen different insurers and all of them said it simply wasn't possible to cover us for January.)

So now it's January 11th and the company says it "doesn't look good" to add us for January because of their contract with their insurance provider. Obviously this is a stressful situation for us, and not having insurance for all four of us is a huge problem. But do we have any legal recourse for the company's mistake? Should we contact a lawyer? 

[smock]

And to make this even more CEP-related: THIS IS WHY TYING HEALTH INSURANCE TO EMPLOYMENT IS STUPID!

[pitta12]

If you have regular ongoing costs like prescriptions, I would have the company agree to cover those costs for the month of January. You could also look into temporary gap insurance like these plans through UHC; just read the details carefully on what's covered and not covered because they tend to be less comprehensive than a regular plan.

www.uhc.com/individual-and-family/short-term-health-insurance

[aurora]

I am definitely not an expert on this, but I would also be very stressed out about it, not to mention angry.

Since your previous policy was through the exchange, is it safe to assume it is not eligible for COBRA? (If it were, you could apply to start retroactively for up to 90 days.)

I don't think it would hurt - other than financially - to contact a lawyer to learn about your options, but assuming he wants to keep the job I would be careful about when to have the lawyer contact the new employer. It does sound like the company is at least trying to keep working with you at this point, unless "doesn't look good" actually means "no."

[kath16]

I had a similar confusing situation last year

It was ultimately resolved because someone on the benefits team spoke to the insurance provider and told them to backdate my coverage. Now, this was a smaller company, but someone at the company should have the power to do this. The EMPLOYER, not the insurance company, sets the terms of eligibility.

The employer needs to resolve this for you.

Barring that, they need to know that they are on the hook for any and all medical expenses that your family incurs for the month of January.

[JayhawkGirl]

I would ask, in writing, for agreement they will cover any healthcare expenses incurred above and beyond the cost of the expected premium during this month due to this error.

I had a similar situation - I started 11/1/99, with a 3 month wait from the first of the month. Since I started on the 1st, my coverage was due to start 2/1/00. It didn't. I later received a copy of my form. Someone at the benefits company changed my 11/1/99 next to my signature to 11/14/99. I was livid. I'm still bothered by how la-di-da my joke of an HR manager was about it. I sign all dates 01/03/09 etc to this day.

[AndyCohen]

This is crazy and the company should offer to pay for any emergency or mandatory health needs that arise in the month of January.

Did the company think he was starting before the first of the month when they told him and then he started on the first or later so it pushed it to another month? Or did they mistake a 60 day wait for a 30 day?

[scout8]

I don't think that it would hurt to contact an attorney, but as of now, you don't really have any damages, so I'm not sure that anything would really happen. Obviously, that changes if you end up needing medical care this month.

I would look into a short term healthcare plan in the meantime. I don't know much about the plans, but that way you would have some coverage in the event you need care.

I would be livid. I would keep pushing them to figure out how to add you to their plan for January.

[smock]

pitta12, thankfully Mr. Smock filled his prescriptions at the end of December because we figured this could happen. And thanks for the suggestion about temporary gap insurance, no one has suggested that and at least it would cover catastrophic situations, which are my biggest concern right now.

aurora, yes, no COBRA option, unfortunately. And you nailed my concerns about contacting a lawyer. I mean, WE aren't the problem in this situation, but bringing in a lawyer could definitely hurt his relationship with the company. My concern is they're going to run down the clock until February and say "look, problem solved itself!"

[smock]

Jan 11, 2018 15:49:31 GMT -5 AndyCohen said:

This is crazy and the company should offer to pay for any emergency or mandatory health needs that arise in the month of January.

Did the company think he was starting before the first of the month when they told him and then he started on the first or later so it pushed it to another month? Or did they mistake a 60 day wait for a 30 day?

He was hired as a contract employee at the beginning of November and offered a full-time position later in the month. I think his local HR person confused the start dates, but technically both should have been in November, since that's when he signed paperwork. 

And kath16, he did talk to HR about retroactively changing his start date so he'd be eligible, and the HR person (who I do not like) was like, "Oh, I don't think we can. Contracts. Blah blah." 

[captainobvious]

Typically the team can make an administrative exception, which wouldn't violate any contractual obligations but would allow for an enrollment outside of the regular requirements. It sounds like their HR/Benefits person doesn't know what they're doing or doesn't want to do something that requires a little bit of work on their part.

[smock]

Oh, and this is a Fortune 500 company with billions in profits, and they also just cut a bunch of holiday time (eliminated floating holidays, cut paid holidays to 5 for the year), AND they are apparently violating the state's sick time policy by pretending they have fewer than 50 employees when they actually have almost 60,000.

I already hate them. I told Mr. Smock to go on strike until they give us health insurance.

(and yes, he's already looking for another job.)

[smock]

Jan 11, 2018 15:57:18 GMT -5 captainobvious said:

Typically the team can make an administrative exception, which wouldn't violate any contractual obligations but would allow for an enrollment outside of the regular requirements. It sounds like their HR/Benefits person doesn't know what they're doing or doesn't want to do something that requires a little bit of work on their part.

That's the impression I'm getting. But it's now been forwarded to the VP of HR for the company, who hopefully can make something happen, because I'm suspicious that they're just trying to run out the clock. It's been three weeks since they realized the error, and so far nothing has happened, not even an apology.

[aurora]

Jan 11, 2018 15:52:43 GMT -5 smock said:

pitta12 , thankfully Mr. Smock filled his prescriptions at the end of December because we figured this could happen. And thanks for the suggestion about temporary gap insurance, no one has suggested that and at least it would cover catastrophic situations, which are my biggest concern right now.

aurora , yes, no COBRA option, unfortunately. And you nailed my concerns about contacting a lawyer. I mean, WE aren't the problem in this situation, but bringing in a lawyer could definitely hurt his relationship with the company. My concern is they're going to run down the clock until February and say "look, problem solved itself!"

I do get where you're coming from, but looking at it from more of an outsider's perspective (and this is probably how his company's HR is looking at it)...isn't this last point true, in a sense? I mean, you have health insurance to protect you from outrageous medical bills, and assuming you don't end up having any of those (or really any medical bills) by 2/1, wouldn't that mean that the problem is no longer a problem? If that were to happen, what would you want the company to do on 2/2?

All of that said, I'd definitely ask them to cover a temporary/gap policy as others have pointed out, and I'd also push back on the company vs. the insurer deciding eligibility as my next steps. (kath16's post reminded me of a deal my sister was able to negotiate with her employer, who wanted her to start a couple of days later, but she didn't want to because it would mean an extra 30 days without insurance, so they just reduced the eligibility time for her.)

[aurora]

Jan 11, 2018 15:48:39 GMT -5 JayhawkGirl said:

I would ask, in writing, for agreement they will cover any healthcare expenses incurred above and beyond the cost of the expected premium during this month due to this error.

I had a similar situation - I started 11/1/99, with a 3 month wait from the first of the month. Since I started on the 1st, my coverage was due to start 2/1/00. It didn't. I later received a copy of my form. Someone at the benefits company changed my 11/1/99 next to my signature to 11/14/99. I was livid. I'm still bothered by how la-di-da my joke of an HR manager was about it. I sign all dates 01/03/09 etc to this day.

OMG, that sounds criminal! Did you report the company (I'm not sure to whom; someone in your state government?)?

[Tacocat]

A few years ago when I left a job to start a new one, there was a gap of a month between when my old insurance stopped and my new insurance started. I was able to buy a 1 month plan with Blue Cross Blue Shield for my family (2 adults, 1 child) for a pretty reasonable price. It was MUCH cheaper than the COBRA plan offered by my previous employer. I'd look into something like that for your family and maybe the new employer will cover the cost.

[captainobvious]

Jan 11, 2018 16:02:09 GMT -5 smock said:

Jan 11, 2018 15:57:18 GMT -5 captainobvious said:

Typically the team can make an administrative exception, which wouldn't violate any contractual obligations but would allow for an enrollment outside of the regular requirements. It sounds like their HR/Benefits person doesn't know what they're doing or doesn't want to do something that requires a little bit of work on their part.

That's the impression I'm getting. But it's now been forwarded to the VP of HR for the company, who hopefully can make something happen, because I'm suspicious that they're just trying to run out the clock. It's been three weeks since they realized the error, and so far nothing has happened, not even an apology.

Hopefully the VP is able to make the decisions vs. the HR generalist/Benefits Specialist. I know it's kind of a pain to do from the HR side because you have to contact a bunch of people and explain you made a mistake, but sheesh. (And I know this because I've done it a half dozen times.)

[pitta12]

HR may push back on making an administrative exception because those can lead to issues with stop loss coverage (assuming the plan is self-insured) as well as non-discrimination rules and other complications. We generally advise employers to avoid administrative exceptions if at all possible, and if they do intend to make one to consult with counsel and clear it with the plan administrator and stop loss carrier in advance. I have seen many a time where HR tries to be nice and make an exception and ends up with huge stop loss claim denials. It is not pretty.

[seeyalater52]

Yeah there is NO WAY they can't just backdate the policy effective date. I truly do not believe there isn't anything they can do. They should be prepared to pay for a gap policy for you if they can't fix it internally. That should be non-negotiable.

In terms of not having coverage for this month beyond the immediate concern of how to pay for anything you need during this uncovered month, you should be ok starting on 2/1 without too much drama. There's no mandate anymore, so not having coverage won't trigger any sort of penalty. And there's no issue with continuous coverage for things like pre-existing conditions or whatnot anymore. So basically I'd be REALLY PISSED, but probably wouldn't burn it down over this in case it impacts his relationship with his employer.

I'm sorry this happened, I can imagine it must be very stressful to deal with.

[JayhawkGirl]

Jan 11, 2018 16:05:35 GMT -5 aurora said:

Jan 11, 2018 15:48:39 GMT -5 JayhawkGirl said:

I would ask, in writing, for agreement they will cover any healthcare expenses incurred above and beyond the cost of the expected premium during this month due to this error.

I had a similar situation - I started 11/1/99, with a 3 month wait from the first of the month. Since I started on the 1st, my coverage was due to start 2/1/00. It didn't. I later received a copy of my form. Someone at the benefits company changed my 11/1/99 next to my signature to 11/14/99. I was livid. I'm still bothered by how la-di-da my joke of an HR manager was about it. I sign all dates 01/03/09 etc to this day.

OMG, that sounds criminal! Did you report the company (I'm not sure to whom; someone in your state government?)?

I didn’t. Me today would. Young me then didn’t know what my recourse could be.

[smock]

Jan 11, 2018 16:03:44 GMT -5 aurora said:

Jan 11, 2018 15:52:43 GMT -5 smock said:

pitta12 , thankfully Mr. Smock filled his prescriptions at the end of December because we figured this could happen. And thanks for the suggestion about temporary gap insurance, no one has suggested that and at least it would cover catastrophic situations, which are my biggest concern right now.

aurora , yes, no COBRA option, unfortunately. And you nailed my concerns about contacting a lawyer. I mean, WE aren't the problem in this situation, but bringing in a lawyer could definitely hurt his relationship with the company. My concern is they're going to run down the clock until February and say "look, problem solved itself!"

I do get where you're coming from, but looking at it from more of an outsider's perspective (and this is probably how his company's HR is looking at it)...isn't this last point true, in a sense? I mean, you have health insurance to protect you from outrageous medical bills, and assuming you don't end up having any of those (or really any medical bills) by 2/1, wouldn't that mean that the problem is no longer a problem? If that were to happen, what would you want the company to do on 2/2?

No, you're absolutely right. I just want them to suffer for their mistake! I need compensatory damages for my pain and suffering! (that's a thing, right? My L&O degree isn't completely clear on that.)

[smock]

Thanks guys, this has been really helpful. I've got some leads on a short-term policy that look promising, so at least I won't have the fear of medical bill bankruptcy hanging over my head. This has been especially stressful because my stepfather was just hospitalized for four days because of a random infection, and now has to be on infusion antibiotics for six weeks, and I keep thinking about the what ifs of being uninsured. (thankfully, he seems to be doing better.)

And seeyalater52, I did check that one month gaps didn't trigger penalties under the ACA. I was concerned about the pre-existing conditions since Mr. Smock has a few of those. Still, I'll throw in a "fuck the GOP" for good measure.

[captainobvious]

Jan 11, 2018 16:09:53 GMT -5 pitta12 said:

HR may push back on making an administrative exception because those can lead to issues with stop loss coverage (assuming the plan is self-insured) as well as non-discrimination rules and other complications. We generally advise employers to avoid administrative exceptions if at all possible, and if they do intend to make one to consult with counsel and clear it with the plan administrator and stop loss carrier in advance. I have seen many a time where HR tries to be nice and make an exception and ends up with huge stop loss claim denials. It is not pretty.

And this is way I avoid working on self-insured plans.

[isabel]

Honestly, I'd find a gap plan and take them the information and ask that they pay for the cost of it above and beyond the costs that you would incur if you were on the company's plan. Get it in writing if they agree to it. And assuming that nothing happens between now and February 1, I wouldn't stress about it past that date.

[aurora]

Jan 11, 2018 16:26:46 GMT -5 smock said:

Jan 11, 2018 16:03:44 GMT -5 aurora said:

I do get where you're coming from, but looking at it from more of an outsider's perspective (and this is probably how his company's HR is looking at it)...isn't this last point true, in a sense? I mean, you have health insurance to protect you from outrageous medical bills, and assuming you don't end up having any of those (or really any medical bills) by 2/1, wouldn't that mean that the problem is no longer a problem? If that were to happen, what would you want the company to do on 2/2?

No, you're absolutely right. I just want them to suffer for their mistake! I need compensatory damages for my pain and suffering! (that's a thing, right? My L&O degree isn't completely clear on that.)

Believe me, I get it. I had a taste of something similar the two years in a row my mortgage holder "accidentally forgot" to pay my homeowner's insurance out of our escrow. I definitely deserved compensation for the stress of worrying I'd be destitute if our house burned down! (Bright side: their incompetence eventually helped us get out of escrowing.)