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Question

health insurance coverage - dependent coverage between age 19 and 25 Currently have retirement coverage for myself and family. Verizon goes by Federal Mandidated Law and contracted with Atnea Insurance for our coverage. Atnea will only allow coverage of our 22 year old IF he is a full time student or will cover if he is disabled and living at home full time. Washington State Health Care law states insurance conpanies must allow coverage for dependents to age 25, they do not have to be full time students. How can Atena deny our son coverage now that he is not in school.

Submitted: 35 days and 21 hours ago.
Category: Legal
Value: $38
Status: CLOSED
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Optional Information

State/Country relating to Question: Washington

Posted by Tina G, BBA, JD 35 days and 21 hours ago.

Answer

Thank you for contacting our JA team for guidance.

The more stringent law applies. Therefore, if your son is a dependent and state law requires that he be allowed as a dependent under state law, the health insurer must recognize this state law.

If they continue to refuse, I would consult with a local employment law attorney about drafting a demand letter and possibly a lawsuit for vexatious refusal to pay if there are claims pending. This would allow for punitive damages against the insurer, which often motivates them into paying the claims.

The state bar association can provide you with attorney referrals.

Please let me know if you need additional information.


Best regards to you,

TG

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35 days and 21 hours ago.

Reply

, Verizon Retirement plan contracted with Atena Health Care. I contacted Atena to get a price of having a separate policy just for our son. They do not offer independent policies in the State of Washington, only through corporate contracts with large companies as in Verizon. Verizon does offer continuted coverage under Cobra if you notify them within 60 days of dependents change of status. Our son did quit school and is not living at home and we are still supporting him. However, we have missed the 60 day notification. Had we not we would we would have had the option to continue his health insurance coverage under "Cobra" , without missing a beat. The down side is it would then not be covered under my retirement premium discount, it would be at a current price of $550 per month. For a 22 year old. He has a pre existing condition of cancer which he is in full remission. Getting him covered through any other insurance company we have found requires a physical, or disclaimer showing no pre existing condiditon. What are are legal rights to get him coverage now.

Accepted Answer

Unfortunately, since the 60 day notice was missed, there is no legal obligation to continue coverage unless it was the fault of the employer or insurer. In addition, you would need to show that your son was a dependent on your tax return. It is very unlikely under these circumstances that you could force Verizon to insure him.

I am sincerely sorry as there are many of us with medical conditions who cannot get coverage. Hoping that will change soon, but not holding my breath.

A last resort is to look for federally qualified healthcare providers in your son's area. They must provide income based healthcare.

All the best to you and your family.

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Expert: Tina G, BBA, JD
Pos. Feedback: 99.1 %
Accepts: 
Answered: 10/20/2009

Lawyer.

licensed attorney for 12 years including employment, business, contract, domestic, and general civil

35 days and 2 hours ago.

Reply

Thank you. But doesn't Atnea have to cover our son based on Washington State Health Law, and not Federally Mandated Health Law, even if they don't offer individual policies in Washington State?

Accepted Answer

Yes, but if the WA law allows the insurer to require a notice period and you missed that, then you would no longer be eligible to includ him on your coverage.

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Expert: Tina G, BBA, JD
Pos. Feedback: 99.1 %
Accepts: 
Answered: 10/20/2009

Lawyer.

licensed attorney for 12 years including employment, business, contract, domestic, and general civil

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