I was notified on August 14 that my benefits provider dropped my dependent on July 31. ?

Question

Many within my company underwent a dependents audit to determine if their dependents still qualify for medical coverage under our health plan. I faxed the info to them (as requested) but they said they cannot find it. As a result, they dropped my dependent son (who is in college) from my medical plan. Do they have to offer COBRA coverage? They dropped him on July 31 but notified me of their decision on August 14. I am appealing their decision. Should I go to the state attorney general?

Answer 1

Yes, they offer Cobra, but you can contest it.  You should be able to send them a copy of the fax log, showing it was received, or the fax confirmation sheet.

Are you claiming your son as a dependent on your tax return?  And is his legal residence, your house?  Is he a full time student?   If any one of those things aren't true, then it's highly possible he does NOT qualify to be a dependent.

It's not uncommon for kids to drop a class, without telling mom & dad, which moves them to part time.  

Answer 2

If you need help call your insurance commissioner.  In California their website is www.insurance.ca.gov

Answer 3

I used to work for a large national company that does dependent eligibility audits.

You should have a window of time where you can appeal the dropping of your dependent.  Read the notice you received about your dependent dropping - it should be spelled out in there.  (Generally, I believe the time frame for appeal is 30-60 days of the decision or so.)

If you have your fax confirmation from when you originally sent the info, submit that along with a letter explaining the situation and another copy of your information.  You shouldn't have any problems getting your dependent added back to July 31st with no break in coverage.

If you do not have the fax confirmation or other proof that you actually faxed the info, write an appeal letter describing the situation and also send in a copy of the documentation.  If your information is complete, they may still accept your son through the appeal process.

The purpose of a dependent eligibility audit is to drop ineligible dependents...generally, from what I've experienced while working in the field, as long as you can prove eligibility during the appeals process you would have a good chance of getting him added back on.  (Unless your employer/HR department has insisted on strictly adhering to the deadlines...some HR departments get frustrated with employees who refuse to respond and/or continuously ask for extensions on the info, so they finally throw up their hands and say "no exceptions - this is the deadline.  Period."  If your HR department is taking that stance, then you'll definitely want your fax confirmation!)

Keep in mind also that there are generally multiple warnings/reminder letters issued throughout the audit process...if you continued to receive notices saying "we have not yet received your info..." you definitely should have called to confirmed that your fax was received!

The state attorney general is not the appropriate person to complain to for a dependent eligibility audit - you'd want to go to your Human Resources department.  The HR department is the one who hired the outside firm to do the audit, and the HR department ultimately has the final say on any appeals and/or accepting information after the deadline.

Good luck!

Answer 4

As long as you can prove that you did in fact fax the requested info, and can prove that your son is in fact a full-time student who meets the eligibility requirements for coverage, the insurance company should re-instate your son. It may be something as simple as a clerical error-especially since there may have been many employees sending in the info in the same time frame. Follow the guidelines set forth for the appeal and cc your states insurance commissioner's office. Until you have satisfied all appeals processes, there is no grounds for going further. If you are still not able to get your son reinstated, then you may wish to contact the insurance commissioner's office in your state for further guidance.