Insurance provider paid claims for an ineligible dependent Does the dependent now have to pay the paid claims?
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Here's the situuation: My mom added me as a dependent and she thought I just needed to be a student in order to be on her medical insurance. She added me to her plan on 10/9/09 and she had 60 days (according to the benefit provider's website) to submit documentation that I am eligible to participate. To further complicate matters, my mom found out that she must be providing at least HALF of my support and because I am single, living on my own and have a mortgage in my name, that would make me ineligible for the insurance benefit as a dependant. If claims were paid since the start of the plan year 1/1/10, and because I am not an eligible individual on her plan, would I be responsible for paying the paid claims even though the insurance company did not request the documentation BEFORE paying any claims for me? I have read some laws about dependant coverage and COBRA if they become ineligible, but it seems that I have been ineligible from the start, despite a Benefit Administrator at her work advising her that i was eligible.From what I was reading, if I become ineligible, I can obtain COBRA benefits under the same provider and plan so long as I pay the premiums, which cannot be more than 102% of the premium costs for an individual that would qualify. Here is some information that may help determin my case: I live in Florida I have had approximately $5000 in healthcare costs since 1/1/10 because of an echocardiogram ($3840), and several doctors visits with specialists. The provider is an HMO providing insurance for a large employer (5000+ people) Any information would be greatly appreciated.
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Answer:
The plan SUBSCRIBER has to reimburse the insurance company. The employer's contract with them *might* allow them to attach her paycheck. Correct, it doesn't seem like you're eligible for COBRA, because you flat out weren't eligible for the insurance coverage in the first place.
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