Hubby's Employer Excludes WLS. What now?

faithmd · February 13, 2008

Wheet, you are BRILLIANT!!! Anyone ever tell you that? Luv ya!!!!!!! Love reading your posts!

Oh yes, brilliant AND eloquent, a smashing combo.

Futr littl Debi · February 14, 2008

Come to think of it, I know nothing of contract law, but I would think that making an exception for just in person, outside of cases of extreme and unique disability, would be grounds for a lawsuit on behalf of all the others for whom the exclusion remains in-force...

Wheetsin, you are correct. Group insurance carriers are not permitted to have different provisions for individuals under a contract. Companies can buy different insurance plans for different categories of employees (officers vs. regular workers), but it has to be clear what the categories are and the purchased plan has to apply to everyone in the category.

If the insurance is an individual plan, then the individual could buy a rider for their coverage that wouldn't apply to anyone else that the insurance carrier covers. But that's one of the main differences between Group and Individual insurance.

chloemom · February 14, 2008

It's funny because the HR dept. of his work, and UHC rep both said the same thing the True Results Lady said about the insurance. It would make sense that it would have to be across the board. I just want to try to get it covered.. maybe he excluded it because no one ever asked. Maybe I will pave the way for banders at hubby's job. According to hubby, many people need it.

I would go to Mexico or pay out of pocket but hubby and I are buying a business and all available cash and credit have to go to that. If anything, I will have to wait until our business opens and I will do the payment plan.