Cancellation of Health Benefits

[Guest susanyb]

The husband of a co-worker had his company insurance cancelled because he was deemed to be "a risk". Not only was he not allowed to enroll during 2006 open enrollment for medical, but he was also denied access to their company's dental and vision coverage.

At the same time he was allowed to remain in the company 401k, AD&D, STD & LTD programs.

My question - is it legal to isolate certain employees and deny them continued coverage?

[leevena]

Seems to you probably need an answer from someone who is familiar with the laws/regulations in the state of this company plan. I am in California and would not be able to answer questions about other states. Perhaps if you add some more information, such as state the plan was issued in, size of company, was it a self-funded or insured plan, etc. Also, if you could expand on what the term "a risk" means. I am assuming it means that the person has a medical condition that is likely to cause significant claim dollars.

Good luck.

[Mary C]

I believe under HIPAA you are not allowed to discriminate against someone due to health conditions in a group plan.

[Guest b2kates]

I agree, on its face such exclusion appears to be a HIPAA violation.

[Guest Steve72(b)]

I agree with MaryC. If this is a group health plan subject to ERISA (which, based on the original post, it sounds like it is), lasering out individuals as health risks is prohibited regardless of whether it is self-insured or fully insured.

The EBSA, which is an agency of the Department of Labor enforces the relevant laws.

[GBurns]

Who cancelled him? The employer or the insurance company?

Who prevented him from enrolling and How?

Have they issued him anything in writing?

Have they issued him a Certificate of Creditable Coverage?

Has he been offered COBRA?

While the group health plan itself is subject to ERISA and therefore DOL EBSA, there is still the issue of state law regulating the insurance policy itself and the insurance company.

Check with your state regulator (Dept of Insurance) regarding coverage issues and state version of HIPAA. Get beyond telephone Customer Service. Try to get someone in Market Conduct.