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Relative’s private health insurance canceled.

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  • Feb 28th, 2015 4:49 pm
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[OP]
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Nov 5, 2009
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Relative’s private health insurance canceled.

As per the title of this post, just trying to help a cousin who is going into depression from the loss of his private insurance policy.
Background: Cousin worked at a local Montreal company that makes lenses. He worked there for 1 year back in 2003. After a year of employment, he suffered a work accident. Quebec’s workman’s comp declared him as permanently disabled.
Before the work accident, he signed up for the enhanced plan of the company’s private insurance. After his accident, and for the next 10 years, the company provided plan paid for all his, and his family’s medical costs. His medical coverage continued even when the employer changed insurance providers.

Nov. of 2014, he receives a letter telling him that his coverage is terminated. The reason given was that he is permanently disabled. The letter also stated that they will not ask him for $14 k in premiums the company paid on his behalf. Also, no more free prescription glasses for him and wife.

My cousin is very depressed and since he has a heart condition, I am worried about him and trying to help. I hope someone here can too.

If you're wondering why this is posted in the shopping section, There is a reason why. I have been trying to post in the off topic but because of the "accept" forum rules glitch, I have not been able to post for a week now. No one has fixed the issue yet.
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Jan 3, 2014
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redflag5050 wrote:
Feb 27th, 2015 8:42 pm
Before the work accident, he signed up for the enhanced plan of the company’s private insurance. After his accident, and for the next 10 years, the company provided plan paid for all his, and his family’s medical costs. His medical coverage continued even when the employer changed insurance providers.

Nov. of 2014, he receives a letter telling him that his coverage is terminated. The reason given was that he is permanently disabled. The letter also stated that they will not ask him for $14 k in premiums the company paid on his behalf. Also, no more free prescription glasses for him and wife.
So...he got 10 years of free premiums and coverage for medical services, presumably had plenty of time to put away some savings or look at some other options "just in case" and now he's getting a letter saying that free coverage is terminated and you're posting why, exactly?

It's unfortunate he's in this physical condition, but 10 years for permanently disabled is pretty good coverage. There's likely going to be some coverage available through government programs for permanently disabled people, so I would suggest he contact the government to discuss options and possibilities.

It doesn't appear that the employer or the medical insurance company did anything wrong. If anything - if he was classed as PD shortly after the accident (you don't say with certainty, but the impression I get is that this is the case) - the employer and medical insurance company went above and beyond. In some cases (accident compensation aside) health benefits are usually intended to work toward the employee's return to work and if they're not able to go back to work, they are discontinued.

Definitely contact the government for information. Your friend should call...not you...because there may be some relevant questions that determine the answers he gets and you don't want to exacerbate the situation by assuming and getting incorrect info.
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[OP]
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Nov 5, 2009
738 posts
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ALLCAPS wrote:
Feb 27th, 2015 9:24 pm
So...he got 10 years of free premiums and coverage for medical services, presumably had plenty of time to put away some savings or look at some other options "just in case" and now he's getting a letter saying that free coverage is terminated and you're posting why, exactly?
Because his coverage was the enhanced one which included provisions for disability. The basic plan cost was $5 a week for the employee. The enhanced plan cost was $25 a week per employee. He had the accident in 2005 and was declared permanently unfit to return to work in 2007. Wouldn't be logical for the medical coverage to stay in place especially since it is not the insurance company that is paying his salary, the Quebec workman's comp is.
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redflag5050 wrote:
Feb 27th, 2015 10:57 pm
Because his coverage was the enhanced one which included provisions for disability. The basic plan cost was $5 a week for the employee. The enhanced plan cost was $25 a week per employee. He had the accident in 2005 and was declared permanently unfit to return to work in 2007. Wouldn't be logical for the medical coverage to stay in place especially since it is not the insurance company that is paying his salary, the Quebec workman's comp is.
Actually, since he is no longer an employee (I'm presuming his employment was officially terminated once he was deemed to be PD since he clearly wouldn't be returning to the workplace), it's illogical for the employer's insurance plan to pay. In most cases, the "insurance company" (Great West Life, SunLife, etc, whichever company it is) isn't the one that's actually paying - I believe they just administer the plan on behalf of the employer, who is actually funding the coverage.

The policy wordings would outline the limitation of coverage (both dollar value and duration). The fact that there was a specific point in the letter referring to the company not planning on reclaiming $14k in premiums paid by them gives me the impression continuing coverage for so long was an oversight on the employer's part and that they were paying premiums (and by extension, providing coverage) when they either wouldn't normally have been or they shouldn't have been. If coverage and premium payment had been a normal part of the process, there would not have been the need to make a reference that element. Even if it was not an oversight, I don't think it's unreasonable for the employer's plan to terminate coverage after 10 years.

As already written though, I would expect there is medical assistance or coverage available for people under WC or on PD, so your friend should contact the government to discuss available options.

May the force be with him.
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Your relative would have to see what the CSST (Quebec's workers comp.) says about the employers obligation to maintain employee benefits. In Ontario, for example, the employer must maintain employment benefits for only one year after the accident. After which point, the injured worker is SOL and loses all coverage. Since employment benefits are part of your total compensation at work, they really should be considered for workers compensation. But this is just another way that an injured worker gets screwed by the system. In Ontario at least, the WSIB does not provide any other coverage to make up for the lost coverage and I suspect this would be the case in other provinces since they all copy each other striving to pay as little as they can.

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