Employer changed health insurance - need info!?
Question:
New policy/company went into effect Jan. 1st. We were notified Jan. 10th of our new group number and on Jan. 18th we received our informational booklets on the new company.
My situation is this: I saw a dr mid-Dec who scheduled me for surgery Jan. 17th. Surgery was performed (and now I'm all better), but this new insurance policy requires the individual to pay the first 1500.00 out of pocket and they will cover the rest. Our previous company required us to pay 20% of the cost (which in my case is much cheaper than the $1500).
I need to know what laws apply to my situation. Thanks!
Answer:
If this is a fully-insured plan, in all likelihood, there is no insurance law pertaining to the situation. This is because most employers are exempt from being regulated under insurance laws by ERISA, even if the plan is fully-insured.
It's important for you to understand that, in a group insurance situation, the employer is the policyholder. As policyholder, the employer has the sole right to change or discontinue the plan at will. So your permission isn't required before any kind of plan change.
While it would have been courteous (to say the least) for your employer to notify you before the change, what would you have done if you found out on 1/1 that you'd have a $1500. deductible to meet? You couldn't have purchased an individual medically underwritten plan, because you have a pre-existing condition.
If you have an employment contract signed by your employer that guarantees your insurance won't be changed, or other verbiage to similar effect, then your claim would be against your employer. If you belong to a union, ask your union representative if this matter is discussed within any collective bargaining agreement it has negotiated with the employer.
The laws on notifying employees of changes to their health coverage varies from state-to-state. Unfortunately, I don't know Minnesota's laws. To complicate things, if you work for a large company that "self-insures" they may be exempt from state laws and, instead, come under a federal law known as ERISA.
That's the bad news. The good news is that your employer probably used an insurance agency to buy coverage for you and your colleagues. Insurance agents understand the local laws and are paid to help you through these kinds of issues. Ask your office manager or HR department for the name of the company's agent and call them. You've done a good job of laying out the problem and a professional agent should be able to get you the help you need quickly.
Best of luck.
Speak with an attorney (personal injury will do). If the surgery had anything to do with your work, you may be entitled to recovery of part or all the money spent toward the surgery.
Worker's Compensation Benefits require certain procedures. Speak with an attorney and let him know the details of your situation. He/She may agree to represent you on a contingency basis (he recovers if you recover -- except court cost and filing fees).
The laws in each state vary. That's why it is important to take your case to someone who will evaluate based upon your situation. Explore the site below:
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