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Ginnabee | Am I due a refund from my health insurance company if...? |
My insurance dropped coverage on my husband after they said I couldn't prove we were legally married. They asked that I send my tax documentation filed for 2006 proving that I filed as married. This is impossible, since I only file taxes every 3 years. I offered to send a marriage CERTIFICATE, not a license, and they refused. The reason they are requesting proof is because my SS card still has my maiden name on it and until I have that changed, my payroll with my employer is under my maiden name. But that's a whole differenct story! They said they can only accept the tax documention they requested. So, now they've dropped him and I've been paying on his coverage for a little over a year now. Is this crazy?!!! I think I should get my money back considering I CAN prove we are married but they won't accept the form of proof!!!!!!!! If I'm not due a refund, then should I take them to court?
Additional Details
I can get away with filing every 3 yrs because I never (& never have) owed. Also, no claims were ever filed with the insurance company for my husband so they haven't fulfilled any type of service. Yet they have received my $$ for a full year and NEVER once asked to prove my marriage status, until now! OF COURSE! |
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mbrcatz
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Health insurance is purchased on a month to month basis. They can't cancel retroactively, you can't collect a refund retroactively. If there had been a claim, they would have paid it.
You don't NEED to change your name when you get married.
Write to your state insurance commissioner, and complain. Enclose a CERTIFIED COPY of your marriage certificate - also known as a marriage license.
Be prepared - if you win the complaint, you'll have to pay the retroactive premium from the date of cancellation, and he'll be added back on, from the date of cancellation. |
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sarah314
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I've worked on eligibility audits for medical benefits, and tax documentation is commonly requested. (A marriage certificate is not sufficient documentation because it only proves that you were married at one time - not that you're still presently married.)
The fact that you have a different last name shouldn't be an issue or an audit trigger- many women choose to keep their own name these days. My guess is that your company is going through an audit process for all employee's dependents.
And no, you're not entitled to a refund of any money. Typically, they don't make the cancellation retroactive. Rather, they set a current removal date for all dependents who are removed as a part of the audit process. You don't get a refund for premiums paid if your husband had coverage during the time period the premiums were paid for.
If your empoyer/insurer chose to void your husband's termination retroactive to the date of coverage (and I'd be exceptionally surprised if that was the case), you could potentially be entitled to a refund for premiums paid. However, this would hapen *if and only if* your husband didn't receive any services on the policy. Otherwise, the insurer can deduct any medical expenses they paid out on your husband's behalf from any premiums you may have paid on the policy that was retroactively voided. Once again, I strongly suspect that they will just cancel him from here on out.
2 other points I wanted to add:
1) Is this an individual policy that you purchased, or is it a group policy through your employer?
2) If its a group policy through your employer and they are dropping your husband as a result of an audit, you should have appeal rights to the cancellation. What I would do is either file 2006 taxes (as someone else suggested) so that you have proof OR come up with other documentation to demonstrate that your marriage is current. For example, some audits will permit use of proof of joint ownership (current mortgage statement or bank account in both of your names, etc.) in place of tax documentation. Just because your audit didn't accept those documents as proof initially doesn't meant that they might not consider them on appeal. But you definitely need to have something more than just your marriage certificate to prove marital status...that's just the way it is, unfortunately. |
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bmwdriver11
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Yikes. Get your name changed with the Social Security Administration. That took my wife about 30 minutes of effort, probably less. How is it that you think you only have to file taxes every 3 years? Thats extremely dangerous ground to tread- all citizens are required to file yearly if they owe taxes. You are risking jail if you are not filing yearly.
Lastly, no, the Insurance company wont owe you anything. If you can prove that you are married, then they will likely pay the hospital/doctor in question, and you'll need to try to get a refund from them. You could potentially sue the insurance comoany to cover him, but that is going to cost you a lot of $$- it would be far cheaper to start following the law and filing your taxes like you are supposed to, or getting your name changes with the SSA. By the way, see if they will take the marriage CERTIFICATE. In most states, the marriage license just means that you CAN get married, not that you ARE married. Which is why nobody, the SSA included, will take it as proof that you are married. The state issues the marriage certificate after you are married, and does serve as proof that you are legally married in the eyes of the state. |
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Barry auh2o
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No refund. They would have covered you had you sent them what they required. They earned the premium, they keep it.
This filing a tax return every three years doesn't do you any good. You should file one annually,. even if you owe no tax.
Such a big deal over nothing ! What a waste. |
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stephenweinstein
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File a 2006 tax return, even if it is not required by the tax laws, and then send a copy to the insurance company. Problem solved. (If you were really not required to file, then there will be no tax due when you volutarily file, and no penalty for late filing.) |
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Brian A
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No, you aren't due a refund unless you have paid for some coverage in advance. You were presumably covered in the past for the time that you paid so you got the service you paid for even if you didn't use it.
I am curious about how you get away with only filing every three years. One solution would be to file for 2006 now and send them the papers they want. |
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always an opinion
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That sounds really odd. They came back a year later and revoked his coverage? Have you spoken to your broker about this? He/she should be able to resolve this for you. If they cannot and he does get terminated from the plan then no you would not be entitled to a refund. The reason is during the time you were paying the premium he was receiving the benefit. They could not go back and refuse to pay the claims he had while he was on the plan so it is only right that you would pay the premium. If they try to go back and deny the claims then you have a reason to sue. They took your premiums and that led you to believe he had coverage and you acted accordingly. There is a big law suit that was just settled in CA dealing with this. As long as they acted like he was covered and you were paying like he was covered then he was. |
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Jen
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Get a copy of your marriage license from the county and state you were married. No big deal. Lawyers would cost too much money. |
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Sugar Magnolia Says GO CHIEFS!
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Just because you kept your maiden name doesn't mean you aren't married. insurance companies suck, & they will do whatever it takes NOT to benefit you. I would say, talk to a lawyer & see what you can do. If you are legally married, you should have no worries.
Good Luck
PS-how come you only pay every 3 years? i thought you had to file every year? |
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