Termination of Health Insurance in Connecticut

[jsiegrist]

What is the name of your state (only U.S. law)? Connecticut

I have an unusual situation involving my former employer, a public school system in Connecticut.

I had a baby on 6/20/2014. I informed my employer on 7/5/2014, that I would be taking a year leave on absence as per my contract. All the contract says is that I must inform in Superintendent in writing. I did that and cc'd the building principal. I also checked with our Business Manager to see what I needed to do. After several email and phone calls I finally talked to him and he said all I needed to do was send in the letter. I had spoken to his secretary (who handles all HR for the district) and was told that I would still be eligible for benefits during the leave of absence, but with no cost share. I would be required to pay the full amount starting 9/1/2014. This would cost about $2400 per month. I stated over the phone that I did not want that. After sending in the letter, I did not hear anything from my employer and did not receive any paperwork. I did not even receive a confirmation that the letter had been received. I arranged for different insurance to begin coverage on September 1, 2014.

In November, 2014, I was informed by my doctor that I was still listed as active by Aetna, the health insurance I had had through my employer. I contacted my employer and spoke to the Business secretary. She informed me that I needed to fill out paperwork to cancel and emailed it to me. She told me to back date it to Sept 1. I filled it out and sent it in. I never heard back.

In March, 2015, I was again informed that I was still listed as active. I called my employer and spoke to the Business secretary. She said that she had not received any paperwork from me. She also informed me that I would probably owe the district all the money back to September that I hadn't been sending in. She chastised me for not sending in checks. I was shocked. At that point we were talking about $16,800. I had scans of the paperwork I had sent in in November. She said to send them in and she "would see what she could do." I emailed them to her on 3/17/15. Over the next several week I called repeatedly and left messages, but I never got a call back. I emailed several times, too. On 3/30/15 I emailed and got no reply. On 4/13/15 I emailed and asked what was going on. On 4/20/15 I got a reply that said "I’m sorry but I haven’t heard back from them. I will give them a call again today and update you." I never heard back.

On 4/24/15 I resigned my position. I never received any paperwork from my now former employer. I got an email from my principal that acknowledged I had resigned. That is all I heard from the district.

On 6/29/15, I received ID cards for the Aetna insurance. I immediately contacted the business secretary by email. She emailed back that she had never received my paperwork to cancel the insurance. She attached the paperwork to the email and said that if I filled it out, she would "take care of it for me." I responded that I had in fact emailed it to her, had the email to prove it, and had an email from her that she was in the process of canceling and was waiting to hear back from Aetna. She has not responded.

At this point, I am so frustrated. I am also terrified that my former employer is going to bill me for $24,000. How could they claim twice that they didn't receive my paperwork? Especially when one of the times I have the proof! How can they never contact me unless I hound them? How can they never notice that I was not sending them thousands of dollars each month? Can they legally do this? Can they legally charge me for the entire back payment? I have never received any information about COBRA. This made sense when I thought that my health insurance had been cancelled, but now that I know it was still active when I resigned, shouldn't I have been offered COBRA? (It's not that I want COBRA, but I feel like this is another place where they have screwed up!)

Please help!

 

[cbg]

(35+ year HR/Benefits professional here)

When they actually bill you for the $24,000 come back and tell us then. There's no point in trying to deal with what-if situations that may never happen.

If they had cancelled your insurance, then yes, they should have offered you COBRA. But no one is going to offer COBRA when you're still active, even if you're active by mistake. I have been involved in a similar situation (my husband's ex-wife failed to cancel his insurance when we were married, and he was covered on her plan for well over a year longer than he should have been without us being aware of it) and we were told by the DOL directly when she cancelled it finally that he was NOT eligible for COBRA since he'd had coverage during his entire COBRA period. He didn't get an additional 18 months because ex-wife screwed up.

It is remarkably easy to overlook the fact that someone on COBRA is not sending in payments. Anyone who's every worked in Benefits will tell you that. The fact of the matter is, no one has time to audit their bill every single month; many places don't have time to audit their bill more than once a year - or two.

I'm still looking for your proof that they received your cancellation. I see where they acknowledged your resignation. That is NOT the same thing.

 

[Ladyback1]

What is the name of your state (only U.S. law)? Connecticut

I have an unusual situation involving my former employer, a public school system in Connecticut.

I had a baby on 6/20/2014. I informed my employer on 7/5/2014, that I would be taking a year leave on absence as per my contract. All the contract says is that I must inform in Superintendent in writing. I did that and cc'd the building principal. I also checked with our Business Manager to see what I needed to do. After several email and phone calls I finally talked to him and he said all I needed to do was send in the letter. I had spoken to his secretary (who handles all HR for the district) and was told that I would still be eligible for benefits during the leave of absence, but with no cost share. I would be required to pay the full amount starting 9/1/2014. This would cost about $2400 per month. I stated over the phone that I did not want that. After sending in the letter, I did not hear anything from my employer and did not receive any paperwork. I did not even receive a confirmation that the letter had been received. I arranged for different insurance to begin coverage on September 1, 2014.

In November, 2014, I was informed by my doctor that I was still listed as active by Aetna, the health insurance I had had through my employer. I contacted my employer and spoke to the Business secretary. She informed me that I needed to fill out paperwork to cancel and emailed it to me. She told me to back date it to Sept 1. I filled it out and sent it in. I never heard back.

In March, 2015, I was again informed that I was still listed as active. I called my employer and spoke to the Business secretary. She said that she had not received any paperwork from me. She also informed me that I would probably owe the district all the money back to September that I hadn't been sending in. She chastised me for not sending in checks. I was shocked. At that point we were talking about $16,800. I had scans of the paperwork I had sent in in November. She said to send them in and she "would see what she could do." I emailed them to her on 3/17/15. Over the next several week I called repeatedly and left messages, but I never got a call back. I emailed several times, too. On 3/30/15 I emailed and got no reply. On 4/13/15 I emailed and asked what was going on. On 4/20/15 I got a reply that said "I’m sorry but I haven’t heard back from them. I will give them a call again today and update you." I never heard back.

On 4/24/15 I resigned my position. I never received any paperwork from my now former employer. I got an email from my principal that acknowledged I had resigned. That is all I heard from the district.

On 6/29/15, I received ID cards for the Aetna insurance. I immediately contacted the business secretary by email. She emailed back that she had never received my paperwork to cancel the insurance. She attached the paperwork to the email and said that if I filled it out, she would "take care of it for me." I responded that I had in fact emailed it to her, had the email to prove it, and had an email from her that she was in the process of canceling and was waiting to hear back from Aetna. She has not responded.

At this point, I am so frustrated. I am also terrified that my former employer is going to bill me for $24,000. How could they claim twice that they didn't receive my paperwork? Especially when one of the times I have the proof! How can they never contact me unless I hound them? How can they never notice that I was not sending them thousands of dollars each month? Can they legally do this? Can they legally charge me for the entire back payment? I have never received any information about COBRA. This made sense when I thought that my health insurance had been cancelled, but now that I know it was still active when I resigned, shouldn't I have been offered COBRA? (It's not that I want COBRA, but I feel like this is another place where they have screwed up!)

Please help!

While your employer may have failed to do their part, I have to ask: Did you ever think to call Aetna, and find out why they still had you active, and what YOU could do to remedy the issue?
Sorry, but my first call would have been to the insurance company--then the employer.

(of course, I'm a bit of a rebel like that!)

 

[ajkroy]

I will always defer to cbg on these matters, but I didn't realize that a leave of absence would trigger a qualifying event sufficient to terminate insurance outside of the enrollment period. Possibly someone at OP's school didn't realize that, either? Obviously, the baby would open it up, but timing is key here.

 

[cbg]

The IRS has set certain life events as qualifying for insurance changes. Each employer then decides which, if any, of these events are going to be qualifying for them, and sets them in the plan document. For my employer, an LOA is definitely a qualifying event. I've never worked anywhere that an UNPAID LOA was not, though paid LOA's may or may not be.

But you're quite right that the OP's administrator may not have caught that, or even known it, depending on what their position was and how they were trained. There are other possibilities too; in my office, we don't know if someone has had a qualifying event of any kind until someone tells us. If you've gotten married, had a baby, had your spouse or partner lose or gain coverage, etc., it's up to you to tell us, but if you're eligible to make insurance changes because of a change to your job, it's up to your department to tell us. If they don't tell us till six weeks after the fact, then we don't know till six weeks after the fact. And we did have one case, not too long ago, where we weren't notified till well over a year later.

Bottom line - yeah, the employer screwed up. No question about it. But from my perspective as a benefits person, I can see a number of valid explanations for it. I'm not putting blame on the OP (though when she didn't get a follow up after her 6/29 phone call, she really should have confirmed) but I think the employer has a valid defense, too.

 

[jsiegrist]

Thank you for your replies!

The only proof that I have that they received the cancellation is the email I sent on 3/17. It had the cancellation paperwork attached and was sent to the correct email address. That is why I emailed it the second time - so I would have that proof since they don't confirm anything.

Maybe I shouldn't have brought COBRA into it, since I don't want COBRA. To me it was just another example of how they aren't doing their jobs. If I quit my job, is it my responsibility to also find the cancellation paperwork and cancel my insurance? It might be, I just don't know. We used COBRA when my husband was laid off back in 2008 and everything was handled for us.

I never thought of the qualifying event. As a teacher I didn't receive paychecks over the summer, so I pay for my summer insurance in one big lump sum from my past paycheck. Open enrollment starts 7/1, but by that time I had already paid for insurance until 9/1. I don't know how that would effect it. The LOA was unpaid. The person who runs all of this is the secretary for the Business Manager. There is no HR department.

I can understand that in a large company they might not notice that someone wasn't sending in checks to pay for insurance, but I was the only person in the district on a LOA.

I don't know what 6/29 phone call you are referring to, but I agree that my major fault in all of this was not following up more and assuming that everything was taken care of. New baby and all. I'll try calling Aetna today.

ETA: I realized that you said the might not notice that I was not sending in checks for COBRA. I just wanted to clarify that according to the district I wouldn't qualify for COBRA during my LOA. I would just be on the insurance as an employee and they would keep paying my insurance costs and I would pay them back for it by sending them a check. So they have been sending Aetna money for my insurance all year.

 

[cbg]

Doesn't matter whether it is COBRA or an LOA. Any time there is someone who is making direct payments instead of payroll deduction, it is frighteningly easy to overlook it when people don't send in the checks. Bill audits take a lot of time and frankly, there are always so many more immediate issues that it takes a back seat, and often doesn't get done more than once a year, if that. On our last audit we found people who hadn't paid in years. We didn't charge them back but we did tell them that the free ride was over - our bad for not catching it sooner, we'd eat the charges up to that point. Going forward, you pay every month or you get cancelled. And after 35 years in the business, I can tell you that we're better managed than most, and we STILL ended up eating hundreds of thousands of dollars.

My mistake on the phone call. You said it was an email. Again, I'm not putting the blame on you but for future reference, CALL, don't email. Follow up with an email - you've found yourself that it's good to have the "paper" trail. But get someone on the phone whenever you can, take names, write down dates and times. Then email back, read receipt requested, with a "to confirm our discussion of an hour ago, you are responsible for doing this and in return, I will do that" type email.