Please Help: Employer failed to maintain health insurance coverage. Now what?

Quitting is probably a really bad idea, especially now that you're looking at self funding a birth.

HIPAA doesn't provide any protections here. There IS no policy to maintain, since the employer cancelled it. And it's probably too late to add her to YOUR policy.

Suing the employer for fraud, isn't going to work. This isn't fraud. They'll claim accounting error.

What you need to do, is twofold: 1. file a complaint with your state labor board, to get the money back for the insurance she never received and 2. look into an employment benefits liability lawsuit. He's only "on the hook" for medical bills that would have been paid, if he had insurance, UNTIL you found out he no longer carried insurance.

Look, he's not required to provide health insurance benefits to any employees. Now that you know there's no health insurance, he's not on the hook any more for benefits you WOULD have received IF the policy had been in place.

She's going to have to either find another job with benefits pretty darned quickly, or hope he starts a group plan again. Because you're right, now that she's pregnant, she's uninsurable on private health insurance, even if you CAN find one that offers maternity coverage (good luck on that).

Her insurance is only going to come through a job - either yours, or hers, and it will have to be a NEW job, unless YOUR employer offers coverage and has open enrollment pretty darned soon so you can add her on.

HIPAA does provide for individual policies even if the group policy is no longer in existence. It is called a "portability policy" and it can be purchased through many of the major individual companies. However, you have a deadline where you must get the new policy within 63 days of loosing your previous coverage. In addition - in most state portability policies do not include maternity coverage any longer (as a result of the healthcare deform act) although they will cover complications of pregnancy.

These policies also have a higher premium, usually starting out around $1000 per month and up. If you don't qualify or can't afford the high premium you need to contact the doctor and hospital, tell them you are now a cash paying client, and start pre-paying the delivery services. Most likely you can negotiate the delivery down to $3000 - $6000.

Your other option would be your state welfare system if you qualify financially. Google "Medicaid + your state" to find the website contact information for your location. The website for most states will have the qualifications as well as the application on-line.

HIPAA provides no protection to maintain the same policy. HIPAA provides certain protections related to getting new policies, but you have rejected that possibility.

COBRA provides protection to maintain a policy, but only while the employer continues to have health insurance for some employees; if everyone's policy has ended, then COBRA is not an option.

Even if you had known, she could not "have just paid the entire premium to avoid cancellation." This type of policy can be maintained only if the employer pays for multiple employees; otherwise, the insurance company cancels the policy. Individuals cannot maintain it alone. The insurance company will not accept the premium from her or from you, only from the employer. Your statement "Otherwise she would have just paid the entire premium to avoid cancellation" is false. She would not have been able to do that. No matter what she did, if the employer did not pay, then the insurance company would cancel the policy.

In addition to Medicaid or State Insurance -- did you try private insurance? I am an independent contractor and I purchased it through Costco as they have a program for individuals within their savings negotiations for their customers.

If you have had previous coverage (at least up until the end of this year ...) you can apply for coverage from other insurance companies. My only concern is that your wife has a "preexisting condition" -- which is pregnancy. But you may be able to get around it since your coverage was until end of 2010 and you are looking for coverage w/in the 6 month window.

Double check and each state is different, etc but don't give up looking and trying to get insurance.

Congratulations on your baby -- wishing you a healthy and happy baby! -- make sure your wife takes plenty of prenatal vitamins, etc... you can buy generics at the health store or the drugstore -- that will do for now until you can get a prescription.

Enjoy!!

I can't believe that the insurance company didn't send out termination notices. That's what they do here if the employer is behind. If 60 days hasn't passed then you should be able to get a HIPAA policy which is no questions asked coverage.

Get professional advice - it's no good relying on comments from strangers who can only ever know the bare facts, not your particular circumstances in the necessary detail.