Emblem Health Inc. Reinstates 8,000 Members They Wrongfully Terminated
By Joe Randazzo Published: January 30 2014
An investigation by A.G. Schneiderman found EmblemHealth Inc. wrongfully denied coverage to 8,000 young adults on their parents’ health insurance plan.
An investigation by Attorney General Eric T. Schneiderman found the health insurer, EmblemHealth Inc, violated multiple New York state laws which requires young adults to receive continued health coverage on their parents’ policies. Schneiderman’s office has now reached a settlement with Emblem which requires them to reinstate coverage to more than 8,000 young adults who were unjustly terminated, and pay $90,000 in denied claims.
“The people of New York recognize that young adults need affordable, quality health coverage—and that includes having the option to stay on their parents’ insurance through their 20s,” said Attorney General Schneiderman. “This settlement sends a message to insurance companies that want to do business in New York: Providing health coverage to New Yorkers also means playing by the rules and following the laws of our State, which are often stronger than federal regulations.”
The investigation started after a complaint from a mother who claimed her 26-year-old daughter’s health coverage had been terminated on her birthday. The federal Affordable Care act states families can keep their children on their insurance until 26, while in New York State, health insurers must continue covering members until 30. Due to being wrongfully terminated, the complainant had to pay $5,000 between treatment and additional bills when her daughter went to the hospital.
Schneiderman’s investigation found that the 26-year-old woman and approximately 8,000 other Emblem members did not receive the required termination letter. Now the health insurer must reinstate all of these members while doling out $90,000 in unreimbursed medical treatment.
The settlement also requires Emblem to submit to monitoring, an independent audit, and pay $100,000 to the OAG as a civil penalty.
The State’s Age 29 Law was enacted in 2009 and extends a young adult’s health insurance under their parent’s plan through the age of 29. Under the Young Adult option, insurers must provide written notification to group members to let them know they have the right to purchase continuation coverage for their children within sixty days. The 29 Law also states an insurance company must notify members of termination 60 days before the date.
[Source: Attoreny General Schneiderman]