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Attorney2
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Experience:  28 Years In General Practice,
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I recently received the following communication from a

Customer Question

I recently received the following communication from a company WageWorks:
"As previously communicated by PPG you will be transitioning to direct bill for your retiree medical premium effective with your September 1, 2016 premiums.
Payments are due by the 1st of the month. Therefore your payment for September must be postmarked by September 1. If you do not remit your premiums in accordance with the requirements, your coverage will terminate retroactive to the latest paid thru date." No mention of late fees or allowance for holidays etc. etc. Late one time and you are done.
Is this even legal?
Submitted: 4 months ago.
Category: Legal
Expert:  Maverick replied 4 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.

Expert:  Maverick replied 4 months ago.

I will need to let someone more experienced in this area assist you. Your deposit is still in tact and you need not do anything on your end...

Expert:  Attorney2 replied 4 months ago.

I have pulled up WageWorks can you tell me was PPG handling the billing for WageWorks? Did that billing contract end/terminate?

Customer: replied 4 months ago.
No, PPG transferred their administration and obligation in retiree pension liabilities to Massachusetts Mutual Life and Metropolitan Life Insurance. The insurance companies apparently hired WageWorks to collect retirees' medical insurance payments from PPG retirees starting in September per above.
Expert:  Attorney2 replied 4 months ago.

That is what I thought but I did not want to make any assumptions. You are entitled to exactly what you were promised. This stinks of insurance fraud. They will need to have this investigated immediately as they are basically stealing the money you paid in.

Please file a complaint online today with the FTC https://www.ftc.gov/faq/consumer-protection/submit-consumer-complaint-ftc

The State Department of Insurance (while I look up the laws) at http://www.insurance.pa.gov/Consumers/File%20a%20Complaint/Pages/default.aspx

This is the link for the laws and regulations and I am going through them now http://www.insurance.pa.gov/Regulations/Laws%20Regulations/Pages/default.aspx

The State Attorney General/Insurance Fraud Department https://www.attorneygeneral.gov/Criminal/Insurance_Fraud_Section/Insurance_Fraud_Referrals/

There must be a grace period and it MUST be 31 days:

The grace period in Pennsylvania is 31 days.

§ 82.24. Mandatory policy provisions.

(2) Grace periods which comply with the following:

(i) For scheduled premium policies, a provision for a grace period of at least 31 days from the premium due date which provides that, if the premium is paid within the grace period, policy values will be the same, except for the deduction of an overdue premium, as if the premium were paid on or before the due date.

(ii) For flexible premium policies, a provision for a grace period beginning on the policy processing day when the total charges authorized by the policy that are necessary to keep the policy in force until the next policy processing day exceed the amounts available under the policy to pay the charges in accordance with the terms of the policy. The grace period shall end on a date not less than 61 days after the mailing date of the Report to Policyholders required by § 82.74 (relating to warning statements for flexible premium policies). The death benefit payable during the grace period shall equal the death benefit in effect immediately prior to that period, less overdue charges. If the policy processing days occur monthly, the insurer may require the payment of not more than three times the charges which were due on the policy processing day on which the amounts available under the policy were insufficient to pay charges authorized by the policy that are necessary to keep the policy in force until the next policy processing day.

(3) For scheduled premium policies, a provision that the policy will be reinstated at any time within 2 years from the date of default upon the written application of the insured and the furnishing of evidence of insurability, including good health, satisfactory to the insurer, unless the cash surrender value has been paid or the period of extended insurance has expired; upon the payment of outstanding indebtedness arising subsequent to the end of the grace period following the date of default together with accrued interest thereon to the date of reinstatement; and upon payment of an amount not exceeding the greater of one of the following:

(i) All overdue premiums and indebtedness in effect at the end of the grace period following the date of default with interest at a rate not exceeding that permitted by section 410(k) of the act (40 P. S. § 510(k)).

(ii) One hundred ten percent of the increase in cash surrender value resulting from reinstatement plus overdue premiums for incidental insurance benefits with interest at a rate not exceeding that permitted by section 410(k) of the act.

(4) A full description of the benefit base and of the method of calculation and application of factors used to adjust variable benefits under the policy.

(5) A provision designating the separate account to be used and stating that:

(i) The assets of the separate account shall be available to cover the liabilities of the general account of the insurer only to the extent that the assets of the separate account exceed the liabilities of the separate account arising under the policies or contracts supported by the separate account.

(ii) The assets of the separate account shall be valued as often as policy benefits vary but at least monthly.

(6) A provision specifying what documents constitute the entire insurance contract.

(7) A designation of the officers of the insurer who are empowered to make an agreement or representation on behalf of the insurer and an indication that statements by the insured or on his behalf shall be considered as representations and not warranties.

(8) An identification of the owner of the insurance contract.

(9) A provision setting forth conditions or requirements as to the designation or change of designation of a beneficiary and a provision for disbursement of benefits in the absence of a beneficiary designation.

(10) A statement of conditions or requirements concerning the assignment of the policy.

(11) A description of the methods of adjustments made in death benefits and policy values—account values or cash values, or both—in the event of misstatement of age or sex of the insured. Examples of acceptable adjustment methods to the account value would be to recalculate from issue using mortality charges based on the correct age or sex or to make no adjustment. An example of an acceptable adjustment method for the death benefit of a flexible premium variable life insurance policy would be to determine the death benefit to be that purchased by the most recent mortality charge at the correct age or sex.

(12) A provision that the policy shall be incontestable by the insurer after it has been in force for 2 years during the lifetime of the insured. An increase in the amount of the policy’s death benefits subsequent to the policy issue date, which increase occurred upon a new application or request of the owner and was subject to satisfactory proof of the insured’s insurability, shall be incontestable after the increase has been in force, during the lifetime of the insured, for 2 years from the date of the issuance of the increase.

(13) A provision stating that the investment policy of the separate account may not be changed without the approval of the insurance commissioner of the state of domicile of the insurer and that the approval process is on file with the Commissioner.

(14) A provision that payment of variable death benefits in excess of minimum death benefits, cash values, policy loans or partial withdrawals—except when used to pay premiums—or partial surrenders may be deferred for one of the following:

(i) Up to 6 months from the date of request, if the payments are based on policy values which do not depend on the investment performance of the separate account.

(ii) For a period during which the New York Stock Exchange is closed for trading—except for normal holiday closing—or when the Securities and Exchange Commission has determined that a state of emergency exists which may make the payment impractical.

(15) A provision stating that if settlement options are provided, at least one option shall be provided on a fixed basis only.

(16) A description of the basis for computing the cash value and the surrender value under the policy.

(17) Premiums or charges for incidental insurance benefits, stated separately.

(18) Other policy provisions required by this chapter.

(19) Other items currently required for fixed benefit life insurance policies not inconsistent with this chapter.

http://www.pacode.com/secure/data/031/chapter82/s82.24.html

What they are doing is against the law in PA.

Expert:  Attorney2 replied 4 months ago.

Please do not hesitate to ask me ask me any additional questions that you may have with regard to this matter. It would be my pleasure to continue to assist you. If you would be kind enough to rate my service so I may receive credit for my work I would appreciate it.

Expert:  Attorney2 replied 4 months ago.

Please ignore the additional services request.

Expert:  Attorney2 replied 4 months ago.

Please do not hesitate to ask me ask me any additional questions that you may have with regard to this matter. It would be my pleasure to continue to assist you.

If you would be kind enough to rate my service positively so I may receive credit for my work I would appreciate it.

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