Can you answer a strange health insurance eligibility question?

What country are you in? If the US, what state?

First, of course, you will want a copy of the letter, as it may contain references to the law, to her hours worked and the guidelines and regulations that you need to appeal against. So, the letter, in your hands and complete with any attachments.

It would also help if you have the name of a contact person at the employer’s HR office (or equivalent) to discuss questions that may arise as you compose the appeal. I would suggest a friendly information-gathering call (you may need to submit some form of power of attorney signed by your mother first, before they will agree to talk with you – I would suggest that you have that ready beforehand so that you can fax it or email a scanned copy immediately.) That kind of readiness will at least demonstrate that you’re not completely ignorant of the legal and security issues that the employer will have in discussing such matters with someone other than the principal – your mother. (I’m pretty sure that you can find power-of-attorney and healthcare-power-of-attorney forms online or in any decently stocked office supply store. So have that ready and available, or ask the company representative if they have a form of their own that they want you to fill out for your mother’s signature, which will allow the conversation to begin. Obviously, it would help to have your mother present during the discussion to avoid long communication lags between questions that they may have for her.

One of the reasons that I would recommend a friendly call to begin with is that she is “so close” to whatever minimum requirement she missed – and obviously she did that in ignorance – so it may be possible to work around the minimum or waive it in this case. Most non-government agencies have a certain amount of leeway they can offer.

It would probably also be helpful if YOU can make the call on your mother’s behalf. That way you can help to keep emotion, recrimination, “you-should-have-told-her” and all of that kind of negative energy out of the conversation. People are a lot more willing to bend the rules for you if they figure that you’re all reasonable folks. If you start with threats, then they may be more likely to adhere to “exactly what the policy says”.

Some of the negotiating points that may work in your favor would be, for example, whether your mother can trade a paid vacation day or sick day – assuming she has any – to make up the shortfall.

In any case, once the conversation has been held, if you can’t get immediate relief, then at least you should have the information that you need to start an appeal.

Good luck!

Wow. What a sucky, sucky situation. I’m sure there was something mentioned when she hired in, but I might have forgotten too. Especially when you’re talking about eight hours out of a whole year.

And…what @CWOTUS said. Good work WOTY.

Thanks! I’m going to see if she can get me a copy of that letter.

We’re both in MA. She works for a large company, and has worked there for about 10 years. Last year, she went to them and asked how many hours she could work and still receive health insurance. They told her 30 (or 32?) hours. But she said she didn’t get anything in writing, and wasn’t told that if she had called in due to a storm or sick, that it could put her eligibility at risk.

Also, apparently, she has called someone. It was a guy somewhere that said he would send out an appeal form that would contain a place to explain why she should still be eligible. Anyway, now to try to talk my mother through scanning this letter with her phone to get me a copy (sigh)..

thanks again.

I wouldn’t start with threats of legal action if I were you. They’re going to clam up and not offer any help because they’re going to think you’re taping them or looking to “catch” them in an inconsistency.

I’d start the letter off with that she’s been a loyal employee for 10 years. @CWOTUS has some great ideas. The possibility of trading a sick day or vacation day in is a great one.

Also, once you resolve it, ask what can be done to help prevent this next year. Her working a few hours extra or few days extra or maybe some kind of online time tracking system that they may have.

Aside from all of the excellent advice you have received here, I would add the following
Ask for a detailed list of the hours and the days your mother worked during the period in question: even the best automated payroll systems are subject to human error. Worth a look and in asking for this, it might prompt someone in HR to review it for accuracy.

Check to see if the hours policy is based on hours worked or hours paid. The former is unusual to me and the latter makes more sense, if an employee uses earned vacation or sick time that should be credited as paid hours.

That is why I recommend a review of how her hours were booked. One paid day shown as unpaid has a huge effect on what happens to your mother.

I don’t follow how your mother fell eight hours short if she worked for the full year and booked an average of 30 hours per week. That is 1,500 hours and in my limited experience, group policy limitations have thresholds of 1,000 hours.

Sometimes mentioning her predicament to someone higher up in the hierarchy than your mother has a positive effect. She has been there a relatively long time, must know people at the VP level and asking someone to run a little interference for her might not be a bad idea. Your mother has to assess this for herself. Do it in a non-aggressive manner.

And overall you should get help on this from HR. No one wants to see a long-term employee lose benefits.

Good luck

She’s so worked up and anxious about this, I couldn’t get her to try to scan that letter. I did confirm that she will be receiving the appeal papers within 2 business days. I will help her fill it out this weekend. Thanks again, everyone. My mother has been in a perpetual state of financial worry my entire life, and she almost lost her house last year.

I’m not in the US, so I’m a bit lost. She short 8 hours of what?

^ Her total hours worked for the entire year are 8 hours less than required for the year.

Ahh okay. So health insurance, which is so vital over there, can be tied to the number of hours worked and people can be dropped by insurance companies and left with no health cover? How awful.

And please let us know how it goes.

Yeah @Earthbound_Misfit that’s another big hullabaloo in the US. If you work less than X hours a week (I think it’s 35 or something, and 40 hours per week us usual) then by law they don’t have to provide you with any kind of health insurance. Some companies will work you right up to that line, say 34¾ per week for that reason.

I still can’t get over 8 hours short for the YEAR. That’s as bad as the government when I got notice that they were cancelling my kid’s state sponsored health insurance because my income for the previous year was $12 over the Magic Poverty Line. I made $1.00 a month too much for my kids to qualify.

I suppose an update is due…

My mother appealed, and appealed again. She went wrote to management at every level, and was met with the same answer: appeal will not be granted.

So, she worked 7 hours too little for the year (I repeat – for the year). Nobody told her or warned her. Apparently, 2015 was the first year the company changed its official policy: no more warning employees. No more buying back hours from earned sick time. No exceptions.

So, that’s it. She’s done. She’s going to have to start transitioning to retirement. She can’t afford to, but she really can’t afford to keep working either. I suspect she’ll end up losing her shack house, and will be living with me in a couple of years.

Oh, did I mention – fuck you, Hillary Clinton and your fucking followers. It’s time for single payer universal healthcare. You and the corporate Democrats are the problem.

…I don’t think the Dems are the barrier to the single payer universal health care issue. I don’t know about Hillary in particular, but look at the uproar the Republicans threw over the first little step towards it, the ACA.

@Dutchess_III: ”…I don’t think the Dems are the barrier to the single payer universal health care issue.”

Well, even the public option wasn’t able to pass with a Democratic majority. Can’t blame the Republicans here.

@Dutchess_III: “I don’t know about Hillary in particular”

She’s completely against it, and has attacked Sanders consistently through this campaign because of his support for it. Her opposition to single-payer has been a large part of her campaign, even sending out her daughter to lie for her multiple times on this issue.

Re: the Repubs and the ACA – this was modeled on what we have here in MA, which was a Republican program. Republicans know they can get away with feigning opposition because there is really no party that is willing to stand up to them. Certainly not the Democrats.

Well, I think the fact that the ACA is in place in spite of their violent protest is proof that someone (hint, he’s a black guy! and a Dem) stood up to them.

When I hear stories like this, it makes me appreciative of being a union member.

Here’s an update:

- After taking away my mother’s benefits because she was 7 hours short for the entire year, she lost all appeals.
– She had to go on Medicare.
– They have been deducting her paycheck since 6/1 for health insurance that they no longer provide for her.
– She has spent every non-working hour on the phone trying to get this resolved, and it has taken a huge toll on her health. She is devastated and very stressed out.
– She was rushed to the hospital yesterday due to a “stress-induced heart attack”. Apparently, she’s going to be fine. She has to be on a couple of medications to get her heart back functioning properly, but she should be back to near 100% in a month. She’s still at the hospital, but they say that she is likely to be released later today.

America #1! or #1,000 or some shit.

That’s so sad @DoNotKnowMuch. Decent healthcare should not be tied to how many hours you work. What your mum has been through is crazy stuff. I’m glad she’s going to be okay.

OMG, that is inhumane, @DoNotKnowMuch. So…where was she at insurance wise when she was rushed to the hospital? Is it going to be an out-of-pocket expense?

^ Medicare. Hope this doesn’t end up being a huge expense. My sister just picked her up from the hospital.

@Earthbound_Misfit: “Decent healthcare should not be tied to how many hours you work.”

You can say that again. Should be no connection between healthcare and employer.

How much was the amount she paid since 6/1 for the insurance which she no longer has? I hope you are getting a refund from the employer.