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marsd

Junior Member
What is the name of your state? IL

A few months ago, the small technology company I work for "merged" with another equally small technology company. Prior to the merger, our medical, and various other benefits, were managed by a third-party company.

Under the previous arrangement, I had several choices as to the policy I wished to enroll into (co-pay, deductible, etc.). I was shown my options for family and chose the plan that was most economically applicable. At no time was I shown a break-down of cost-per-person and, since my wife had always previously carried the insurance through her employer, I didn't know to ask to see it. I just understood that the company was picking up 80% of the premium.

When the merger ocurred, we severed ties with the third-party to move to the partner company's benefit structure. When the representative for BCBS came to present the plan, we were told there would be no options to choose from; we would have to decide, as a group, what level of coverage we wanted. Based on our decision, we were told that the monthly premiums for family coverage would be approximately $1,000. When I expressed concern about this number, the BCBS Rep. stated directly that we were only responsible for 20% of the premium. I then asked him to confirm that I should expect a pay period deduction of around $200, to which he said yes.

A few weeks later, we recveived and enrollment confirmation form (again, stating the roughly $1,000 premium, but no individual breakdown). This concerned me and I contacted the owner of my company directly. As near to an exact quote as I can remember, he said, "remember, you're only responsible for 20%". With this information I signed the confirmation form.

I have just received my first insurance deduction which totaled about $460 for a single 2-week pay period (more than double my previous payment). When I questioned the owner about it, I found for the first time that only the employee is coveraged at 80%; we are fully responsible for the remaining family members.

I feel I was grossly mislead, if not actually lied to, by company management and their representatives. If I had had the correct information at the time, I would have opted to purchase a more economical personal plan.

The reason I cannot just do that now is that a week or so ago (after the new policy went into place), my wife suffered a dangerously accelerated heart rate causing her to be ambulanced to the hospital and receive a prescription for a beta blocker. She has yet to have a follow-up examination with the cardiologist but I am guessing that regardless of the diagnonsis, none of the expenses relating to her her heart issue would not be covered if we switched policies now.

Sorry to be so long winded, but I wanted to give as much background as possible. What I really need to know is am I simply out of luck since I signed the confirmation form? I simply can't afford an additional $450 taken from my income each month. Just as an aside, I have not signed the consent for payroll deduction until this is settled.

Thanks in advance for your time and consideration.
 
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cbg

I'm a Northern Girl
When you asked the employer to confirm the amount you would be responsible for, did you make it clear to them that you would be covering your wife as well?

Is your portion of the premium taken out of your paycheck pre-tax or post-tax? If post-tax, does the option exist for you to have it taken pre-tax? This makes a VERY big difference to the answer to your question.
 

marsd

Junior Member
I made it absolutely clear that I was speaking of family coverage; this is why the premium amount in question was so high to start with. Individual coverage is about $160 per pay period, of which the company picks up 80%.

I am currently someplace where I cannot confirm this but I am about 95% sure this is deducted pre-tax. I don't doubt you when you say that this has some bearing on my question; I'm just not sure how exactly. Could you explain, please? Thanks for your help.
 

cbg

I'm a Northern Girl
Because if the premium is deducted pre-tax or if pre-tax is an option, Federal law limits when you can make changes to your insurance options. You can ONLY make changes either at open enrollment time, or within 30 days of a qualifying event (marriage, divorce, birth, death, adoption etc.). NO exceptions can be made. On the other hand, if the premium is deducted post-tax, then company policy determines when changes can be made and if they choose to make an exception, there is no violation of the law.
 

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