Settlement with EmblemHealth for failing to offer continuation coverage to young adults
NEW YORK - After an investigation uncovered widespread violations of New York law requiring health insurers to offer young adults continuation health coverage on their parents policies, Attorney General Eric Schneiderman announced today that his office has reached a settlement with EmblemHealth, Inc. (Emblem), a health insurance company that provides coverage to 3.4 million New Yorkers, through its Group Health Incorporated (GHI) and Health Insurance Plan of Greater New York (HIP) units. The settlement requires EmblemHealth to offer reinstatement of health coverage to more than 8,000 young adults whose coverage was wrongly terminated, and to pay approximately $90,000 in denied claims.
The people of New York recognize that young adults need affordable, quality health coverageand that includes having the option to stay on their parents insurance through their 20s, said 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.
Following a complaint from a HIP member that her adult daughters health benefits were denied because her coverage had been terminated when she turned 26, Attorney General Schneidermans Health Care Bureau conducted an investigation into Emblems compliance with New Yorks Age 29 Law, which requires health insurers to offer continuation health coverage to children of plan members until they turn 30 years old. The federal Affordable Care Act provides that families can keep their children on their family health policy until the child turns 26. New Yorks law ensures that families can continue to cover their children until they turn 30.
The bureaus investigation revealed that neither the HIP member nor her daughter received a termination notice from Emblem, and they did not receive any notification of their rights, under New Yorks Age 29 Law, to continue the daughters health coverage. Shortly after she turned 26, the daughter received inpatient treatment, but weeks later, Emblem denied coverage, stating that she did not have insurance at the time of her hospitalization. As a result, the complainant was forced to pay $1,000 out of pocket for her adult daughters treatment and faced additional bills totaling $4,000.
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