Group Insurance Policy Details Unknown
Q: The company my husband works for renewed their group health insurance over a month ago. The plan benefits changed (co-pay increases, etc.) along with the employee portion of the premium. He was told that it is virtually the same plan as last year. He has not received a new insurance card or any schedule of benefits. He was told that a new card is forthcoming, but that the insurance company hasn’t provided the employer any schedule of benefits. Does the employer have to provide a schedule of benefits to the employees? Can he call the customer service number on the back of his old card and get the information from the insurance company itself? (He would like something in writing because last plan year there were a couple of misunderstandings that resulted in claims being denied for payment by the insurance company.)
A: It can take time for employees to receive an updated schedule of benefits when their employer changes plans during open enrollment. This is especially true if the decision was made close to the open enrollment deadline. The insurance company should have provided a schedule of benefits to the employer within 10 days of the plan changes. So, they employer should be able to provide you with a copy of this now. It seems odd that the employer has informed you that they do not yet have the schedule of benefits after 30 days after the plan change.
If should definitely contact the insurance carrier to see if they can provide this information as well. They should be able to email it to you in a pdf format. Now, if this is a large company, the new health plan may be customized and not one of the standard health plans offered by that insurance company. This could account for the delay in sending out the schedule of benefits. If this is the case, the insurance company’s customer service department should be able to inform you of this and give you some idea of when you could expect the policy details.
Until this is resolved, you might want to request pre-authorization on any costly claims, such as pending surgical procedures. The insurance company’s claims department would definitely know what changes have been made to the plan and how they apply to any current treatments or medications of existing plan members.
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