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Individual Plan Canceled due to joining a group plan


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#1 gianfranko

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Posted 10 February 2011 - 04:57 PM

So today Blue Cross / Blue Shield told my girlfriend that her individual insurance plan was canceled because she had signed up for a group plan (also from BC / BS that her company started offering this year).

Problem is that the group plan has no coverage for non-generic medication (i.e. gleevec) while the individual plan at least has some.  Originally, the group plan's representative told my girlfriend that she could keep it and she also indicated that she wanted to do in the form signing up for the plan.

I am unsure of what to do.

I have filed an insurance complain / request for help with the insurance regulator of the state.  The complain I put in was the following:

"I have had an individual plan from Blue Cross / Blue Shield ongoing for several years:  Blue Options PPO Policy# XXXXXXXXX

This year, 2011, my company started offering a group plan: Blue Options Policy# XXXXXXXXX.  I specifically asked the representative of the group plan if I could keep both plans and her answer was "yes".  The reason for doing this is my individual plan has much better coverage for prescription medication (non-generic medication), whereas the group plan does not cover anything.
When I signed up for the group plan I specified that I wanted to keep my individual plan.
I just found out today that the company has canceled my individual plan due to me signing up for my group plan.
I need this reversed since the group plan will not cover my current medication (no generic available).
Customer service representative say they are unable to do so.

Please help."

Has anyone gone through something like this?  Any advice as to what can be done?



#2 Trey

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Posted 10 February 2011 - 05:26 PM

There is often a "buyer's remorse" clause in contracts which allow cancellation within a stated time period, which is often rather short.  It differs among various States.  I would look into that first (and very quickly), and see if she can un-do the group plan.  Unlikely if it has been very long, but worth a look.



#3 gianfranko

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Posted 11 February 2011 - 05:27 PM

Yep, you were right.  Got things fixed and seems to count as no lapse in coverage.

One makes several phone calls (totally talked to around 3 customer rep from individual plan) and talk to rep for group plan; all confirmed my girlfriend could be enrolled in both plans.  Turns out they were all wrong.

Darn, that was pretty scarry.  We were not looking forward to that $6k per month bill.

Thanks again Trey.

I owe you one (or several actually).



#4 chriskuo

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Posted 13 February 2011 - 07:02 PM

Contact your congressperson.  They can put pressure on the insurance companies.

An insurance plan which only covers generics when a generic is not available does

not deserve to be called an insurance plan.



#5 gianfranko

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Posted 15 February 2011 - 02:57 PM

I agree with you that it seems unreasonable to not cover non-generic drugs when a generic counterpart is not available; specially for drugs that you need to live (i.e. gleevec).

With that said, I personally don't believe in the power of congressman to put any pressure on insurance companies.

Two years ago I had an issue with my group plan and a claim.  I contacted several government agencies and including my congressman and state representative.  None offered any help.

It was finally a lawyer that cleared things up for me saying that my group plan (not sure if all group plans behave the same) was governed by a law called ERISA and was not "friendly".  Advice that was given was for me to take them to court and cross my fingers.

Sorry for my rant.






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