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Employer back dating coverage start date and keeping my money!

Discussion in 'Health Insurance, HMO, HIPAA & Disability' started by kateyface81, Jan 5, 2010.

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  1. kateyface81

    kateyface81 Law Topic Starter New Member

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    Hi All,

    I'm incredibly frustrated.

    October was open enrollment for health insurance at work. I filled out all of the paper work correctly, checked to make sure the secretary had it. Asked her twice about getting my copies of it back. (First she wasn't done with them. Then, she forgot and sent them to the Central Office downtown.)

    From November 1st, they have deducted money for vision, dental, and life insurance. (These are from a separate company and are fine.) They have also deducted an additional $120 every two weeks for regular health insurance through Aetna.

    When I didn't receive my insurance cards, I called the human resources rep. I began calling her in the beginning of December. And never received a response at all. (They had e-mailed temporary dental cards only to some employees. I wasn't one of them.) Today, out of the blue, I get a dental card sent inter office mail. (It was never mailed to my house.) Everyone else stated that they had received the dental cards over a week ago, and they had gotten their Aetna cards a while ago. I called HR and asked to speak to Kathy (the rep) when I was told that she wasn't available, I asked for her supervisor-explaining that I had called repeatedly with no answer. She became available. She was quite rude though. She wouldn't answer anything and told me to call the insurance broker. I did. He said he had never gotten any paperwork for me and that I wasn't in the system. I called HR back, she said that he had a spreadsheet. I called him back; he said he never got the insurance applications. I called Aetna. They said I was never covered. And that there was no way work should have been deducting anything from my check since they weren't paying for insurance. I called everyone back and got the run around. My supervisor called. HR of course didn't answer their phone, but the broker said that if he had my paperwork faxed by 5pm, he would take care of it. HR never faxed my paperwork.

    I asked if I would get my money back, or have it applied to the next few months insurance payment. (I'm not sure who's fault it was. But I wasn't covered.) The broker said that it's illegal for them to put down any other date than Nov. 1st for the date that coverage started. (But I wasn't covered than doesn't matter apparently.) I argues that it has to be illegal to falsify medical or insurance records-which is what they would be doing. And further, isn't it illegal for work to keep the money for services that were never rendered. (Although, I paid for it, insurance wasn't available to me because of a HR screw up.) I can't afford to lose this $600.

    So my question is: Who's right? Can work keep the money and lie about when coverage began?
    Do I have a right to have the actual insurance date recorded and my money returned?
    Is there any documentation that I can cite that would support me in tomorrow's meeting with HR?

    Please help.
     
  2. cbg

    cbg Super Moderator

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    Wow. What a mess.

    Under Federal law, the only time they can allow additions, subtractions or changes to the policy is at open enrollment. If that was November 1, that's technically the only date they can use.

    However, if your HR department erred, and it sounds as if they did, they are allowed to correct an administrative error. So there's really nothing stopping them from correcting it back to November 1 now.

    They MUST either implement your insurance coverage, or return the deductions that were taken. If they do not do one or the other, you can file a complaint with the US DOL, which is the regulatory agency for ERISA complaints (which is what this would be).

    It is possible that Aetna will refuse to go back as far as November 1 (many carriers will only make corrections back 60 days). If that is the case, then they should make the correction to December 1 and refund your deductions for November. Under no circumstances can they keep your deductions but leave you insurance-less.
     

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