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Maverick, Lawyer
Category: Employment Law
Satisfied Customers: 6353
Experience:  20 years professional experience
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I took a leave of absence in January but did not resign my

Customer Question

I took a leave of absence in January but did not resign my position. I received my final paycheck on January 22, 2016. On February 16th, I was in the hospital and had to have surgery. The doctors office requested confirmation of insurance and was informed that the insurance was good and the procedure was covered but when the bill came, the insurance payment was declined.
What are my rights?
Submitted: 9 months ago.
Category: Employment Law
Expert:  Maverick replied 9 months ago.

Welcome! My name is Maverick. Please give me a few minutes to analyze and/or research your inquiry and I will be back.

Customer: replied 9 months ago.
Thank you, I'll be standing by
Expert:  Maverick replied 9 months ago.

NC state continuation laws allow terminated employees and members to continue coverage under their employer’s group health plan when they terminate employment or lose their eligibility under the plan. This applies to fully insured plans purchased in North Carolina. Under State Continuation guidelines, employees who lose eligible employee status may continue their basic health insurance coverage for up to 18 months.

Each individual certificate of coverage must include a notice of your right to continue your group health insurance policy. Notification may also be included on insurance identification cards. Although not required, the employer may give notice orally or in writing as a part of the exit process from employment.

An employee must request continuation in writing. This is usually accomplished by completing a form furnished by the employer. The employee or member may elect continuation, for a period of at least 60 days, after the date of termination or loss of eligibility. All premiums required to bring the coverage current must be paid to the employer, upon the election to continue coverage. The coverage shall be reinstated retroactive to the date of termination or loss of eligibility.

Did you make this election and pay the premiums?

Customer: replied 9 months ago.
No I did not.The question is, how long am I covered after resignation if not electing to continue coverage?
Expert:  Maverick replied 9 months ago.

I was checking to see how long of a window you have to make the election. It appears that you have at least 60 days; but you may want to check if that period was extended by your employer in any way to see if you can make the election now [doubtful, I know].

Because the employer has to provide retroactive coverage during the 60 day window, this is why they probably did not cancel your policy immediately upon termination and this would explain why insurance was confirmed.

More to come...

Customer: replied 9 months ago.
I may not have elected to have the surgery if I had known I was not covered. What recourse do I have?
Customer: replied 9 months ago.
I have purchased good insurance coverage after my resignation with Dynamic but it does not apply to the period of the surgery. I thought I was still covered as indicated by my employer and the insurance company.
Expert:  Maverick replied 9 months ago.

There is no requirement for the employer to subsidize or contribute any portion of the continuation premiums. Also, there is NO GRACE PERIOD FOR PREMIUM PAYMENTS, therefore, premiums must be paid on or before each due date.

That said, you may still have two options here:

1. Check the details of when you paid your last health insurance premium as presumably you would be covered for at least 30 days from that date. So, if there was a deduction for health insurance on your 1/22 paycheck, then you could argue that the 2/16 procedure was covered.

2. Or argue negligent misrepresentation. To state a claim for negligent misrepresentation under North Carolina law, plaintiffs must allege that (a) they justifiably relied (b) to their detriment (c) on information prepared without reasonable care (d) by one who owed the relying party a duty of care. Brinkman v. Barrett Kays & Assocs., 155 N.C. App. 738, 742 (2003)

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Customer: replied 9 months ago.
Thank you for your response. This gives my something to work with.
Expert:  Maverick replied 9 months ago.

You are welcome. Could you please take a moment to assign a feedback rating so JA will compensate me for working on your question. Thank you.