Pre-existing condition clause on insurance

[moleary 2]

Hi - not sure which forum to post in but here it goes...and I hope someone may have some good advice.

We got married on Oct 30, 2010. I have 30 days in which to make changes to my health insurance policy at work and add my wife. I completed the application on Nov 15 and submitted to HR. The insurance company came back and asked for more information. They didn't get the completed application until after the first of Dec, so in their book, we missed the 30 days. I disagree and assert that we submitted our paperwork within the requisite timeframe.

If that argument fails, the next thing the insurance company looks at is lapse in coverage. If there has been more than 63 days since her coverage ended and the application date, they can slap a pre-existing condition clause in her policy and deny claims for the next 18 months for anything she had been seen for in the 6 months prior to her former coverage ending. Since she left her job Sep 13 and they are using sometime in Dec as the application date, this is what has happened.

However, Mexican law states that if you had prior coverage with an employer, and you stop working, you are entitled to the full range of services provided by the national health care system. Our problem is getting the insurance company to tell us exactly what they will accept that attests to that fact.

Does anybody coming from a country with national health care have any experience with getting insurance coverage here?

Thanks!

[nickbits 43]

I think you need a letter from the Mexican government stating that she was covered. I know some people here got similar letters from the Ontario/Canadian government.

However, where is she living? In Canada if you are not a resident you are not entitled to the national health care. I'm guessing Mexico is similar.

Edited February 23, 2011 by nickbits

[moleary 2]

I think you need a letter from the Mexican government stating that she was covered. I know some people here got similar letters from the Ontario/Canadian government.

However, where is she living? In Canada if you are not a resident you are not entitled to the national health care. I'm guessing Mexico is similar.

She's living here now. The Mexican law extends coverage for 8 weeks after you leave your job. She left in August and came here in Sept. We got married and filed for Adjustment of Status. So she was a resident of Mexico until her AOS was approved last week.

[jasoncerri 2]

Hi moleary,

I don't know if this will help, but I'll try. I work in HR and this does happen sometimes. First, if you did indeed hand in the form to your HR on Nov 15 as you state, then your HR messed up big time since they did not submit it in a timely fashion to your insurance carrier. That's a big boo-boo on their part. If that is the case, then you need to walk into your HR office and create a fuss because that is unacceptable.

When we have problems with insurance carriers, we go straight to them and demand that it be fixed. We are a mid-sized company (250 +/- employees) and we have threatened to take our business elsewhere before. Your HR could take that route, it's harsh but it can work. Also, it's an "off the record" type of thing, but usually if you're a decent sized, consistent customer, the insurance carrier will give your company one "exception" per year. Meaning that your HR can mess up one time per year and the insurance company may accept the change as an exception to the rule.

Also, if you can print something from the mexican.gov website that states the law that extends coverage for 8 weeks in addition to proof of her last day at work in Mexico, then that may suffice as well.

Basically, if you handed in the form on 11/15, then your HR fouled up big time and they need to be the ones to fix this and initiate conversation with the insurance. If they are incompetent or not helpful, then take it up the ladder in your company as that may light a fire in HR to get this resolved. If you handed in the form on time, you shouldn't be bearing all the work. Your HR needs to contact their people at the insurance company and go up the management chain until they get this resolved. good luck and let me know how it goes.