Health Insurance Open Enrollment Bureaucracy

Updated on April 05, 2010
J.J. asks from Whitehall, PA
20 answers

Am in desperately need of some good advice. Recently I lost my insurance cover for my daughter because I am working part-time. She is 14 and suffers from asthma, allergies, ADHD and need to see the orthodontist on a monthly basis (she wears braces)
In desperation I contacted her dead-beat dad who has not been around financially or emotionally in the last 12 years of her life to ask if he could add her to his insurance until I resume full time employment. Through lots of prayers he agreed, but now his company is telling me I need to wait until January 2011!! I spoke to an HR representative who was very sympathetic but to no avail. She stated she tried explaining AETNA that she was not added to his insurance before because I did not know his where about until recently. Any advice??? They telling me it needs to be a qualifying event such as the birth of a baby, divorce, death, marriage, and adoption. I keep saying there got to be a way since I do not have $500 a month to pay for medication and medical visits to get the prescription and needed follow ups... I am desperate. Please help.

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So What Happened?

THANK YOU ANGELS... Everyone gave me some sound advice and I am very grateful for it. I am now more prepare to follow-up with them. I'll keep everyone posted. GOD BLESS you all!!!

More Answers


answers from Tulsa on

With group insurance, you generally only have open enrollment for January, usually having to sign up a couple of months before January. If you lose other insurance for a child, sometimes you can sign up within 30 days of losing coverage, otherwise you have to wait for the next open enrollment period. Losing insurance isn't always considered a qualifying event, like birth or adoption is. You can try talking with someone at the insurance company, but I doubt you will get anywhere. The insurance companies are usually set in stone for those kinds of things. They have the possibility of getting in legal trouble if they make an exception for some people and not others. If you don't get anywhere with them, then I would try to adjust your custody agreement and get a court order. That might be the only way you could get her added to his insurance earlier. Good luck!

1 mom found this helpful


answers from Philadelphia on

#1-- Loss of coverage absolutely qualifies as a "qualifying event". This is a federal regulation. You just have to provide proof of your loss of coverage which you can get from either your employer or your former insurance provider.

#2-- If you get a court order for him to cover her insurance, the insurance company must comply. You should be able to file for some sort of emergency hearing on your own without a lawyer. Most family courts have a "self service" center which will tell you which forms to fill out (they can't give you legal advice, but they can tell you which forms to use).

#3-- You should be able to sign up for CHIP while you are getting everything figured out so that she doesn’t miss any appointments.

And just one last point--- once you do finally get it figured out with his insurance company, the coverage will be effective retroactively from the date that she stopped being covered under your plan. So if you have to pay for any appointments out of pocket in the interim, you will be able to file for a reimbursement from the insurance company.

1 mom found this helpful


answers from Dallas on

typically, a loss of employment or change of employment of a spouse that carries insurance constitues a qualifying event - i'm sure a legal decree could constitute that as well. have an order drawn up that dad must provide insurance, not sure how they could deny that. keep trying, don't give up!



answers from Nashville on

As of a year ago, Loss of Coverage was a qualifying event. You may have to get something from your insurance stating you lost coverage due to reduction in hours, and now need to put your daughter on his policy. You don't want to wait, because then you will be without coverage for 63 days and have pre-existing conditions rules that will exclude her asthma, etc. At least that is how it works in my state. Good luck!



answers from Lancaster on

Do you live in PA? go to the state website - - and look at the CHIP program - the state works with private insurance companies to provide coverage for ALL children. If your income is reduced you may qualify for free coverage - and she can be enrolled very quickly.



answers from Philadelphia on

dear J.
apply for medicaid benefits through your county social service agency. I work for gloucester county social services, and processing applications for medical coverage through the state's medicaid program is one of my primary jobs. C. G.



answers from Philadelphia on

I work for a health insurance company. Losing insurance for your daughter through your coverage is considered a qualifying event. Please contact them again and make them aware of why you are now requesting the insurance. The change in your employment/insurance status should be enough to add her to his policy effective immediately.



answers from Philadelphia on

A loss of FT employment (or switching from FT to PT) is considered a qualifying event for healthcare enrollment. I went through this a couple years ago myself and my switching from FT to PT was a qualifying event for me to switch to my husband's insurance. Also, PA has a health insurance program specifically for kids called CHIP. I don't know anything about it, but you should be eligible since the commercials say all children are eligible. It would definitely be worth looking into.


answers from Pittsburgh on

If you are in Whitehall, PA, you absolutely should qualify for "CHIP"!



answers from Harrisburg on

your change of job to part time is considered a "life changing event" in terms of health insurance. The reason for the delay is missing the open enrollment. However you have had a life changing event, going part time. Now if this isn't a change for you and you just can't afford insurance for her anymore then no it isn't a life changing event and by law he can't put her on until January 2011. Hope this helps.



answers from Hartford on

Don't know the rules in Pa, but most of the time loosing another form of insurance counts as a qualifying event. How long has she been uninsured, because there is short window of time. Ask your ex for his benefits book. Once again I strongly believe that loosing an existing policy counts as long as you enroll her in "30 day" (not sure on the time)



answers from Redding on

Dear J.,
I'm sorry you are going through this. It gets very confusing.
I don't know about the laws in PA, but I'm pretty darn familiar with them in CA.
If you no longer qualify for health insurance through your employer because you are now a part time employee, your ex should have been able to add your child within 30 days. All you would have needed was something from the insurance carrier saying that there was a change in coverage due to no longer qualifying.

If it's been longer than that, I don't know what else you can really do. You can try calling the insurance carrier personally. Also, It's not automatic that open enrollments are in January. It depends on the anniversary date of the group policy. An aniversary date can be any month depending on when the policy was put in place. In that case, you have 30 days before and 30 days after to make changes.

It may be possible to get a court order through child support services where your husband has no choice but to add her, but I would caution you about doing this until you know for sure exactly what his group insurance covers.
It may not cover her asthma, allergy and ADHD medications. It may have a high calender year deductible that you have to pay before any benefits are available, it may only cover so many office visits per year. As far as orthodontia, those benefits are almost never covered in standard group health insurance policies and are separate, if offered at all.
In California, we have Healthy Families which is a program for working adults who make too much money for "medi-cal", but not enough to afford other coverage. You should see if there is an equivelant in PA.
Do that first because I know many moms in CA who's exes had to put their kids on employer insurance by court order, but the insurance offered was so crappy it didn't do any good and they lost their subsidised coverage on top of it.
I managed an insurance agency and I ran into this so many times and there was nothing I could do about it. In some cases, I could get an "individual" policy, for the child alone, but having $500 in expenses a month would be cost prohibitive for the insurance company to issue a policy that didn't cost at least that in premium every month.
Call your county public health department and ask them what programs they are aware of and what you may qualify for. It may be a blessing and something like that will work better for you.
I'm not trying to get Dad off the hook by any means, and I think it was great he was willing to work with you on this, but laws are pretty specific as to when dependents can and can't be added to an employee policy.

I wish you the best. Get info about other programs, make absolutely sure what dad's policy even covers in the first place and go from there.



answers from Harrisburg on

1st of all, it sounds like you need to go to court and make him pay his share to raise this child, and he can be made to pay back support as well. This situation is unexceptable.

If you cannot qualify for medical insurance through you or the dead beat, see if you qualify for state aid for medical, temporarily, until things change. The state will look to the dead beat as well. If his medical insurance won't take her as of yet, which absolutley makes no sense cuz if he's on the birth certificate there should be no question on adding her on for the next month's cycle, dead beat is obligated to pay out of pocket equally with you to help to cover HIS daughter's health. The law cannot force an adult to be an emotional parent to a child, but the law does force adults to be financially obligated to their children.

To me, it's a crime against a child to have a parent ignore their child financially. Would you go to court if your daughter's father hit her or abused her in any way? Then why not go to court when your daughter's father is neglecting her by forcing her to have one parent with limited income? He's hurting her by having less in life, including medical attention, food, better housing, clothing, etc.

K. B
mom to 5 including triplets
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answers from Pittsburgh on

if you just had a change in job from FT to PT that made you lose your benefits, that should be counted as a qualifying event.



answers from Seattle on

I have not worked with insurance for 7 years but if I remember correct... Loss of covergae was back then a (QE qualify event) and you have 30 days from date of loss of coverage to get her added to his policy.. ask your HR.. also do you have proof of loss of coverage.. from your preivious insurance? Also just a side thought my daughter has ADD and recently even though I have insurance her doctor gave me a coupon from the Rx manufactor and the precription was free!!! and the coupon is good for 12 months to use.. she is on Foclain XR... or ask dr. for samples ect. althought I know they don't give sample ADD meds.



answers from Pittsburgh on

Have you tried CHIP? I know for sure in PA CHIP covers children who are underinsured or not at all. There are earning guidelines as to who qualifies for the free or even reduced fee insurance. We have CHIP for our kids. It was really quite easy to apply and they were extremely helpful! If it turns out you don't make enough to qualify for CHIP your application will be referred to Medical Assistance. I know it's hard to try to think in that direction but from your post it sounds like it may be a temporary situation. Enrollment is year round. If you were to apply tomorrow she would get coverage most likely by June 1. If loss of coverage is not considered a qualifying event please consider CHIP.



answers from Philadelphia on

I am sorry to hear you are going through this difficult time.

I strongly recommend you contact your local state representative's office. They should be able to assist you with any questions in PA regarding the health insurance coverage of your child. And that is why you elect them into office. To work for you and address your concerns with state/ government programs when they arise. And even though health insurance is a for-profit business, it still is so intertwined with government programs that any representative worth their salt should be able to help you find many options. Also, with the new health care reform changes going into effect with in the next few months, you may qualify for coverage without having to rely on the "dead beat dad". They should be able to put you in touch with a health care advocate who could also direct you if loss of coverage qualifies as a qualifying event to allow your daughter to go on her father's policy.

Don't give up. Especially in PA where there is such a good child's healthcare coverage service (chip).

ann m.



answers from Pittsburgh on

After reading your responses, it sounds to me like you need to talk to someone higher up the "food chain" at your husband's HR dept. Good luck!



answers from Philadelphia on

I would see if there is a loophole in regards to the health of a child. If she has a pre-exsisting medical condition that required constant care may be she could be put on. I would go online and look it up. Another thing to do is to check out insurance through the state in which you live. Most states cover kids under 19 years old who have no other health insurance. Go online and see what the eligibility requirements are. Most likely you will qualify. I think this is offered through your local health department. Good luck



answers from Johnstown on

Hi J.,
Depending on what state you're in, you may very well be eligible to have your daughter qualify for their state-funded CHIP program. Contact your local assistance office for details. Good luck!

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