Why was that employee not insured before the wife needed the transplant? That’s like asking to buy auto insurance after the auto accident occurred. It doesn’t make sense.
It happens all the time. I see it here on the board regularly. Pick any one of the following.
1. The employer only pays for employee coverage. The employee does not elect to cover his wife because she is healthy (until the heart attack)
2. Same thing, but the employee does not cover the wife because she had her own coverage with her employer (until she had her heart attack, and lost her job)
3. The employee just married the wife, and for reasons on his own, did not enroll her during the "open enrollment period" during which 30 day period, she would have been guaranteed issue.
4. The wife was employed and had coverage, but with a lifetime maximum of $1,000,000, so she felt that she did not need secondary coverage, but found out that a heart transplant runs around $1,500,000, or even $3,000,000 if it is a heart, lung transplant.
I could list other reasons. The real issue is that at annual renewal, I am going to raise the premium for the company to a level that they can not afford, so that Mel will cancel our coverage, if wife transplant patient is still eligible. At this point, Mel and all of his employees and dependents are SOL, because small employers are required to have health statements for all applicants. There is a company named Medical Information Bureau that collects health information on anyone in the US. Every time you fill out a health questionnaire, you agree to the fine print that all information may be shared with M.I.B. Insures use this information to see if applicants lied on their health statements. If they did, the insurer rescinds coverage and returns premiums. This is health care in America.
