Why won't my employer let me cancel my health ins now that I'm under my husband's plan? we didn't get confirmation until late.

Asked over 1 year ago - Dallas, TX

Recently married. We decided to go w/my husband's ins plan and we did so within 30 days however we didn't get confirmation for a few weeks. So when we did get confirmation I contacted my employer/ins department and they said I can't cancel since its beyond 30 days but I told them I couldn't without confirmation from my husband's employer, they still said no. Is it not ins fraud for having 2 ins plans (I can't go to the Dr and have them bill both ins co's) so how can they make me pay for 2 ins plans? Is that not fraud? Do I have any basis to dispute?

Attorney answers (4)

  1. Adam Kielich

    Contributor Level 18


    Lawyers agree

    Answered . It is not fraud to have multiple insurance policies as long as your health care providers are not billing both policies for the same services and recovering on the same dollars (it's possible the policies could be stacked). It's also not fraud to be required to pay for both policies since you agreed to pay for both and you are receiving coverage from both, even if you only use one.

    You should obtain the summary plan description (SPD) for both insurance plans and review the claim and appeal process. You can try filing a claim with one of the plans and see if they will release you. If they won't then try filing a claim with the other plan. You may not be able to obtain a release from either plan but that would be the place to start. If the claims are rejected then you may not have a choice but to pay for both policies until one of the plans reaches open enrollment.

  2. Howard R. King

    Contributor Level 6


    Lawyers agree

    Answered . Mr Kielich is correct, it is not insurance fraud to have two health insurance policies. Since both policies are issued by your employers they are likely governed by ERISA and they likely have coordination of benefits provisions in them to prevent health providers from double -dipping.

    Your Summary Plan Description will tell you have to cancel your coverage with your employer's group. It does not make sense that your employer would want to continue to pay for coverage, even if you are also paying with payroll deductions when you would want to terminate the coverage. The group coverage likely costs them some money each month. There may be provisions that only allow to you to terminate coverage at certain times.

    Of course, you also need to be aware whether you have met the deductibles or co-insurance percentages for the coverage year under your policy with your employer. If you you may not want to terminate until the coverage year renews. You likely will incur those out-pocket expenses again under your husband's coverage , if you terminate your coverage with your employer now.

    You should probably also have your husband get his Summary Plan Description as well , so you can evaluate all your options.

    This answer does not constitute legal advice or create an attorney-client relationship.
  3. Sean Patrick Lewis

    Contributor Level 17


    Lawyers agree

    Answered . It is not fraud if you use one ins. co. as primary, and the second one as secondary (thus not billing both as primary for each event)

    You might want to contact an employment attorney for confirmation, but I believe you are stuck for now. When the next open enrollment comes up, you can try to get out of one of the current plans.

    The above is not intended to be legal advice, but may be used for general information. Please contact an attorney... more
  4. Don Karotkin

    Contributor Level 16


    Lawyers agree

    Answered . I agree with the other lawyers who have previously responded.

    I see nothing resembling fraud here. As best I know, there is no reason you cannot tell your your doctor that you have concurrent health insurance with two different health insurers. The doctor's or her billing department is likely used to this sort of thing and will know how to handle it. The insurers are certainly used to dealing with this situation and will certainly know how to handle it as well.

    Assuming that your employer is paying at least a portion of the premium for your coverage, it is curious that they don't seem to be willing to help you get off their plan. Perhaps you could take this issue up again with someone in the insurance department. Of course, if that doesn't work and you're determined not to continue to pay for the insurance, you could quit your job and thereby avoid any further payments. However, I realize that option may not be a financially reasonable one for you.

    Good luck.

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