Life and death insurance issue

System

I am smacking my head repeatedly today.
Employee came to me and asked if she could add her critically ill father to her health insurance bcause his insurance was terrible. I said ,no, no can't be done but let me call our broker to make sure. Well my sweet little broker guy said SURE you can add him as long as she adds him as a dependant on her W2. WOW, I said to myself, I'm learning something new everyday!
In case you don't know the story, management laid off my boss last october while I was out with pneumonia and I really AM learning this as I go along.
After a months worth of phone calls with broker guy over this issue my employee decided to go through with it. She came to me on Friday at 4:30 and said, hurry my dad is having an operation on Monday I need him added today!
Got the paperwork through, went home.
A week after the paperwork went to my broker My insurance agency called me up and said NOOOOOOOOOOOOO you cannot add a parent as a dependant unless she is his guardian. Well broker guy says he told me that. I know darn well that that is a lengthy legal process and I would have remembered him telling me.
So on the week that the father is about to have a lung transfer that he will die without he has no insurance and the fingers are pointing.
I care that her father is ill.
I also care that I may lose my job over this.
Any help?

Parabeagle

Maybe I'm missing something here, but what about pre-existing condition waiting periods? Would the surgery have been covered at all even if he had been added?

Sounds to me like it's serious CYA time. Did you document your conversations with your broker in which he told you could do this? If so, at least you have your side of the issue in writing and that makes it only a little more credible than getting into a "he said/she said" arrangement.

System

That was one of the back and forth conversation that we had during the month the ee was deciding wether or not to go forth with this. He assured me that would'nt be a problem
As for your next point, my head is black and blue by now.
Luckily i coordinated with the ee and we have both come up with documentation
She was in the room with me for a lot of the conversations.

Balloonman

Not to sound mean spirited and heartless, but if he had insurance, crappy or not why would anyone go through hoops to put a significantly ill individual that typically should not be on your health insurance on your policy? If it is not a typical dependent and it requires a near act of God to get them put on there is a reason.
Deez I am not bashing you, so please don't take it that way. I have tried to do things like this in the past to help out, but have found that it causes more headaches than it is worth. Hopefully the employee wasn't dumb enough to have the dad cancel his health insurance before the new coverage kicked in.
I have some young guys who don't sign up for our insurance even though they have none when enrollment time comes up. I used to chase then down repeatedly for the paperwork. Now if they don't turn it in and still don't bring it in after I follow up with them two additional times I document it and don't worry about it. Sooner or later one of them will learn the hard way.
My $0.02 worth.
DJ The Balloonman

System

I really thought I was helping and the ee was so desperate. Believe me I have learned my lesson.
I was under the impression that my broker was paid by us and that his information was valid.This because my former boss really did'nt let me in on the loop. When she was canned noone was there to train me.
Guess what, the insurance company required her to cancel former insurance before putting him on.
For any future posts go ahead and bash. I deserve it.

Parabeagle

You're not the first HR person to fall victim to the misrepresentations of a broker or a carrier, and you won't be the last -- in many cases, a new broker knows less about insurance than you probably do. Don't beat yourself up over it. You learned something and that's what's important at this point.

sonny

If the insurance company REQUIRED her to cancel existing insurance, would they not have part of the cross to bare in this? When they required that, I would think there would have been some direct conversation or somewhere a long the line something in writing on guardian ship? . Sorry for your troubles..know your intentions were good.

MKT

[font size="1" color="#FF0000"]LAST EDITED ON 04-17-03 AT 02:45PM (CST)[/font][p]In response to Parabeagle's question earlier in the thread: As long as there is no break in coverage, there would not have been a pre-existing clause in a group plan.

Hunter1

This is a tough situation, but usually your Summary Plan Description would have an "eligibility for coverage" or similar section. Normally, it would not say that parents are eligible for coverage regardless of their situation, and they just aren't eligible, period. If the plan didn't limit those individuals who are eligible, wouldn't all of our employees want to put their parents, friends, anyone down on their luck, on our health insurance plans? The broker should have known this. Ask him/her what kind of professional liability policy they have, although that's not going to solve the near term problem.
As has been suggested, save any documentation you have, and continue to document, and Good Luck.

AnneLa

Advise the employee to TRY and have her Dad reinstated under his old insurance plan ASAP. What do you have to lose? It's a 50/50 shot. Go for it.

System

I am having a slow day today. This is my third posting but I thought you guys might want an update.
When my finance Mgr, who has positioned himself as my boss ever since they laid off my old one, realized that even he didn't know that our insurance broker was not paid by us to advise us on insurance matters, he and the GM backed off of me. We then contacted our lawyer and they advised us that we should stay out of it and that the ee should hold the broker and possibly our insurance company responsible. I guess our broker works for them by making commission from them. FM and GM called in the broker for a meeting and were shocked at his advice and excuses. At this point the GM started being really nice to me.
Well at the end of the day the broker was frantically trying to get the father on a different kind of insurance, we were documenting everything, and the ee was in a sort of shock.
The next day the father's procedure ended up getting cancelled and he reinstated himself on his old insurance.
The next week the FM the GM and I each received handmade bowls filled with candy and a thank you card from the ee.Unbelievable. I feel I am responsible for putting her father closer to death's door and she thanks me. I am in awe of her.