Determining liability for employers retroactive cancellation of conver

[Guest Nick Desmond]

Fact situation: Employer has small group health plan for employees (@6 members). Employee is terminated and is treated by physician pursuant to group helth plan within the month terminated, after termination but with confirmation that insurance coverage in effect through end of month.

Two months later employeer retroactively cancels that former employee's coverage to before termination date. Treating physician now insists that employee pays the bill for the medical services rendered.

Who is liable:employer, health plan, physician and is ERISA applicable to this group health coverage and if so how? Former employee never received notice of cancellation but ceased using medical services after the month terminated as instructed.

Thank you very much.

[KIP KRAUS]

My first inclination is to check the insurance contract. The contract should specify when coverage terminates followinf termination of employment. Some contracts terminate on date of termination of employment, and some terminate at the end of the month in which employment terminates.

In my openion, the employer should have no say as to when coverage terminates except if given the option when the coverage is initially purchased.

Go to the insurer and ask them to show you the tremination of coverage provisions.

[Guest Killer Joe Ribakoff]

The Plan has gotta pay to the docs bill - for many reasons:

1) State insurance laws are not pre-empted. Most likely, yours will say you can't cancell without notice;

2) The Plan is estopped now from denying coverage.

[Guest JAMESB]

Neither Kip Nor Killer addressed the ERISA covera question. Yes the plan is covered by ERISA but is exempted from filing requirement if it is fully insured. It is covered because welfare plans with fewer than 100participants are not specifically exempted from cover. If employer misrepresents employee status to insurance co. insurance company may not have to pay. However if coverage is cancelled because of failure to pay premiums (See J. T. McCord,A Chilies type restruant) insurance co. could be held liable.

[Guest holly651]

Can anyone lend a guiding hand... I am trying to locate some case references.

Description: employee files suit against employer (not the health insurance company) because of denial of health coverage.

Any web-sites or actual case-names would be greatly appreciated.

[Guest ScottN]

To Holly651: You may want to contact the Colorado Division of Insurance. They may receive complaints (even though this one may not fall under their authority) involving similar issues and may be able to point you in the right direction.