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Your rights when your health plan changes: What if your employer health plan is canceled?
By Insure.com

If your employer automatically deducts money from your paycheck for health insurance, chances are you don't even know whether that money is, in fact, getting passed along to your health insurer. And why should you? You trust your employer to pay the premiums.

But let's say that one day you get a notice stating your health plan has rejected your claim because the policy was canceled for nonpayment of premiums.

"This happens all too often," warns a brochure from the Ohio Department of Insurance. Under Ohio law, the insurance company is in no way at fault in this situation; your employer is. By law, the plan must notify your employer that its health plan is being canceled. In turn, your employer must then notify you of the cancellation within five business days. Failure to do so is a felony.

But if your employer doesn't notify you that your coverage has been canceled, there's little even a state insurance department can do to get your premiums back, your claims paid or your policy reinstated, which means you could be stuck footing some rather hefty medical bills. However, you can start legal proceedings against your employer if need be.

Some states have health plan continuation and conversion laws that allow you to maintain coverage even when your plan is terminated.

The situation is similar in Florida. According to the Florida Department of Insurance, your insurer is not required to provide you with updates about the premium status for group health plans that are (supposedly) being paid by your employer. However, once your health plan has been canceled, the insurer then has 45 days to notify you, as well as your employer. "The contract is between the policyholder (the employer) and the insurance company," the insurance department notes. "The insurance company would not be liable for your claim since the premiums have not been paid."

Meaning: Again, you would be stuck with the medical bills.

Still, there is a modicum of protection.

Some states have health plan continuation and conversion laws that allow you to maintain coverage even when your plan is terminated, including Florida.

Florida law gives you 63 days (from the date you are notified either by your health plan or your employer that your coverage has been canceled) to convert the former group policy to an individual health plan. And a word of hope: That conversion policy might include payment of any outstanding medical claims under your employer's old policy.

In Kansas, if your group policy is cancelled for any reason, including nonpayment of premiums, you are allowed to continue your exact same benefits for up to six months — however, it's at your own expense; you must pay the premiums yourself. The Kansas Continuation Law puts the burden on the insurer, not the employer, to give you notice about your continuation rights.

 

Last Updated March 8, 2008
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