Medical Benefits Not Offered at Time of Eligibility

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msflardigas

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Is an employer required to advise of/offer medical benefits to employee at time of eligibility? If so, what is the time period, or is the employee also responsible for requesting or reminding the employer at time of eligibility?

The purpose of these inquiries stems from several incidents that occurred on separate occasions in which our employer failed to offer medical benefits to employees at time of eligibility. The employees are no longer employed; they have either resigned or have been terminated. The time period during which the employees were denied these benefits range anywhere from 5 months to approximately 1-1/2 years. Isn't there a law that requires employers to pay into a certain fund for these benefits? Are current and former employees entitled to any sort of compensation for the time they are denied these benefits?
 
Sorry, I'm in California. I thought it would show what state I am in because it asks for it the beginning of the thread.
 
There are only two states where an employer is required by law to provide health insurance benefits and California is neither of them. Disability benefits, yes; health insurance benefits, no.

Did the employees ask about receiving benefits and were refused? Or did the employer simply not approach them and make the offer?

Did any of them incur claims that they feel should have been paid?
 
I know with all the jobs I have worked they let the employee's know from the first day what benefits they offer and most jobs I have worked state you're eligable for the benefits after 90 days. I don't believe they never let me know when my 90 days were here. Every so often, they would send an email to everyone stating when the Open Enrollment was, but it was my responsibility to know when my 90 days were here.
 
I understand your point; however, at least you receive an email advising of the next enrollment. I didn't even get the benefit of knowing the type of plan. The only I received is that I a eligible after 90 days.
 
This is what I'm trying to get from you. I am not understanding what you mean by, failed to enroll you.

You received a letter saying you were eligible after 90 days. That fulfills his legal obligation. The burden now shifts to you. He is not responsible for coming back at the end of 90 days and inviting you to enroll.

At the end of the 90 days, did you go to your employer, say, I should be eligible now, and have him refuse to enroll you?

Or did you wait for him to come to you and offer to enroll you?

It was NOT his responsibility to automatically enroll you at the end of 90 days. In fact, legally he cannot do so. He has to have a signed form from you providing the information about yourself and any family members you are enrolling.

If you went to him and said, my 90 days is up, I want to enroll in the benefits plan, and he said no, I'm not going to enroll you, then you may have legal recourse. Whether it would be worth it or not would depend on whether or not you incurred any financial damages as a result.

If you just assumed that coverage would be automatic and that you needn't do anything, then you're pretty much out of luck.
 
Thank you, cbg. I was actually asking this for another co-worker who feels that some sort of compensation should be given since they were saving money not having to pay into a fund for each employee and therefore, some of that money should be given to the employees to put toward another plan. In fact I asked her how she expected to get some type of compensation when she never enrolled and therefore she never paid into it. What I think she really would like to do is report this employer to various governing agencies for violation of CAL-OSHA and California Labor Codes and have them fined/cited for numerous violations, including Business & Professions Code, Code of Ethics, etc. I do, however, feel the same way because they do a lot of things that are unethical and are in violation of several Codes. I just wonder how they are able to stay in business with all of the complaints from clients on how their cases are handled, etc. So for that matter, where can one go to report all of these violations and do it anonomously?
 
I don't know where you, or she, is getting the idea that there is any kind of "fund" for medical insurance that employers are required to pay into. There isn't.

California has such a fund for disability benefits but NOT for health insurance. There is NO requirement in California or 47 other states that employers provide health insurance and there is no fund that employers pay into for medical insurance coverage for their employees in California (or any other state except Massachusetts, and only then for some employers).

You still have not answered my question. Did the employer REFUSE to enroll you (or her) in the plan? Or did the employer simply not remind the employee that it was time to enroll?

Where you report violations depends on the nature of the violation, and at present we have not established for certain that a violation has occurred.

(I reread your posting and this occurred to me; if you (or your friend) is thinking that an employer who chooses not to provide health insurance benefits is required to provide compensation to the employee in order to buy there own coverage, there is no such law in any state.)
 
Numerous violations by employer

I'm sorry for this late reply. In answer to your question about the medical benefits, the employer did not remind or mention enrollment to any employee. I do know that the employee also had a worker's compensation claim also but she was released back to work even though she was still in constant pain and then terminated. Which leads to another question - COBRA. Due to employer not advising of enrollment how does the COBRA rule benefit a terminated employee when the employer never reminded of enrollment and therefore COBRA was not offered. I would think that would have reminded the employer that benefits were not offered. I probably should not say employer because I don't believe the employer is aware of a lot of things that are happening in the office. He is only in the office twice a week during which time the office administrator makes sure she is doing her job. She handles all the books, etc.

To the issue of violations of various codes. First, there are no postings of any kind e.g., payday, worker's comp, minimum wage, rest periods, medical leave, all of the postings that are required by CAL-OSHA, Dept. of Industrial Relations. They smoke in the office during normal business hours and after normal business hours. The reason I say normal is because the office is open 24 hours. They specialize in motorcycle accidents in various states throughout the US, and that one office is the main office where all calls and referrals are processed. The other violation is allowing an employee to work and the income is paid cash and not reported while the employee is on disability and collecting disability benefits. I could go on with respect to their file handling policies just so they can increase their contingency rates. Do you know where all of this can be reported - the state bar?
 
yes or no question, because your language is obscuring the point I am trying to get to and I STILL don't have the answer.

Yes or no. Did the employee know that he, she or it was eligible for health insurance benefits after 90 days? Yes or no. One word answer only, please.

If yes, then question 2:

Yes or no. Did the employee approach the employer and ask to be enrolled in the plan. Yes or no. One word answer only, please.

If yes, then what did the employer say?

We'll get to the rest of the questions when I have a clear understanding of the issue. It sounds very much like you are trying to steer the answer into the one you want and quite frankly, I resent that. I'm not going one step further without clear, unequivocating, answers to the questions above.
 
Since the employee knew that she was eligible for coverage at 90 days and took no action to inquire about how to enroll, she is as much if not more responsible for the situation as the employer.

It was NOT the responsibility of the employer (by which I include all of management including the office administrator) to contact the employee at the end of 90 days and volunteer to enroll her. It was, at that time, up to the employee to say, I would like to enroll in benefits now that I am eligible, may I have the form, please?

I would be saying something different IF the answer to question 1. above had been No, OR if the answer to #2 above had been Yes and the employer had then refused to allow her to enroll. If she had never received any notice at all and only found out after the fact that she could have been eligible, that would be different. Likewise it would be different if she had taken an affirmative step to enroll and was refused. Since, however, the employee knew she was eligible and took no steps to enroll, sitting back and waiting for the employer (again, this includes the office administrator) to take all the responsibility, she is out of luck.

Since she was never enrolled in the plan, COBRA does not apply and is not a factor.

Omitting the mandatory postings can be reported to the state Department of Labor. That is, by the way, considered a minor offense. Violations of smoking ordinances must be reported to the local health department (violations of company policies regarding smoking are an internal issue - there must be an actual law prohibiting smoking before any municipal agency will take action so be certain you know which regulation is being violated). I believe the disabilty issue, which is a much more serious offense, is, I believe, a matter for the DLSE. If not, the DLSE will know where to refer you.
 
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