[Mail_treas] INSURANCE COVERAGE

[CARLA SURBER]

I need some thoughts from some of you who have experienced this before.  This has happened here in the district but never with these same particulars.  Let me share my story.


Everyone was required to electronically sign off on their coverage at open enrollment.  The portal closed for all changes after the last day of the enrollment cycle with the exception of life changing events.  I am sure this is the way that most, if not all of you, function.


Yesterday, I had an individual, one who is politically connected, come into my office telling my clerk that his wife had no insurance coverage upon arrival at the doctor.  We checked and she had electronically waived her health insurance but not dental and vision.  It was clear that she was the one who did the waiver.


In October, she was paid a stipend of $ 1000 for elimination of insurance as per our master agreement.  She was refunded her insurance withholding and eliminated from her portion of premiums for October, November and December.  She has received one pay in December.


In the past there would have been no question to me that open enrollment would have been the next window for entry.  When I called the consortium, they explained that it was my decision and that they could come back in if I wrote a letter.  I am having problems with this.  Is there any type of law that comes into play, either for the employee or the employer?  I thought that I was clear that an employee error still did not allow us to put them back on our plan.  She emailed me yesterday stating that she was surprised when she went to the doctor to find she had no coverage prior to her husband coming to the office.


Although I am sympathetic to the plight of this young family, the lack of reaction for the last three months strikes me that someone  should have realized much more quickly and therefore it would have appeared to be an error.  Yesterday's email is the only one contact that I have received from her, prior to her husband coming in the afternoon.


I would like to deal with this in strictly a legal manner and after the comment from the consortium, I feel that I may be on shaky ground.  I am willing to hire an attorney to understand the district's responsibilities to the employees in fairness to both the district and the employee.  If any of you know of someone well-versed in this area, I would like to know.  This will impact the 1095 forms and the filing for this individual on this year's taxes.


You often bring clarity of thought to these circumstances!


Carla


~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                                     CARLA G. SURBER, CPA
                                            TREASURER, CFO
                                    GREENVILLE CITY SCHOOLS
                          St Clair Memorial Hall-215 West 4th Street
                                    Greenville, Ohio  45331-1423
937 548-3185 x 725 *  937 548-6943 fax *  937 423-0788 cell
                            email @: csurber at gcswave.com
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

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