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Law Educator, Esq.
Law Educator, Esq., Lawyer
Category: Consumer Protection Law
Satisfied Customers: 111450
Experience:  Attorney experienced in commercial litigation.
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Employer provides HMO coverage. I went out of work with a back

Customer Question

Employer provides HMO coverage. I went out of work with a back problem 6 days before my insurance became effective on June 1. Saw the dr on June 4. Have been under the dr's care since the, but cannot get a PLAN surgeon to do the operation before mid to late July. Need surgery and will be out for over a month. I may lose my job. Whether I lose the job or not, can the insurance company drop me if the doctor schedules the surgery that far after I went out?
Submitted: 1 year ago.
Category: Consumer Protection Law
Expert:  Law Educator, Esq. replied 1 year ago.
Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.

I am sorry to say that if the employer terminates you because you cannot return to work, you could be made to pay for your insurance benefits pursuant to COBRA (if your employer has 20+ employees) to continue your insurance coverage, but your insurance would still continue as long as you pay for the benefits. Even if the doctor schedules your surgery that far out, if your coverage is cancelled and you do not continue it under COBRA, then you would not have coverage.
Customer: replied 1 year ago.

what if there are under 20 employees?

Expert:  Law Educator, Esq. replied 1 year ago.
Thank you for your reply.

If there are less than 20 employees, COBRA does not apply and I am afraid the employer can cancel your insurance and you would have to then apply through the healthcare marketplace to get new coverage, so that could mean (unless your new policy covers existing conditions immediately) you could have to wait up to a year before the new plan will cover your medical condition.
Customer: replied 1 year ago.

Is there any law saying how much notice an insured must have under the worst case scenario above? This is not for me, but for a friend without resources.

Expert:  Law Educator, Esq. replied 1 year ago.
Thank you for your reply.

There is no notice required. Upon termination benefits cease. He could potentially qualify for medicaid benefits as well if he is terminated and they would cover existing conditions.
Customer: replied 1 year ago.

Without COBRA how would that be. Under 20 employees. Also, she is a server in a restaurant. Her base pay is $4 per hour. If she is out and not being paid for let's say a month or two months or whatever, but the employer has not formally terminated her, and her record when she was working was more than 20 hours, would she still be considered employed without the formal notification? At present she has texts from the manager saying her job will be waiting for her when she's ready. l I'm going over there now to get the policy. Thanks very much for our effort.

Expert:  Law Educator, Esq. replied 1 year ago.
Thank you for your reply.

Without COBRA, medicaid can still provide coverage for her if she qualifies. She would likely still qualify for medicaid based on what you say she makes.

The employer can notify an employee of termination the day of termination, there is no advance notice required. Benefits cease at termination unless the employer agrees to continue them for some period of time.

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