I was let go from my job on May 12. I was not informed by my employer that I had been terminated from my health insurance policy. Then I received a letter from my insurance company stating I was canceled on May 11. In the meantime, my 12-year-old son was hurt in an accident. I have not been offered COBRA. Can I make my employer or the insurance company liable for the bills? Is it true that the insurance policy has to cover you through the end of the month, or can they just cancel you in the middle of the month?

R.E.

Federal and state law may give you certain rights for continuation of your previous coverage or the ability to obtain non-group coverage. Before you are able to exercise any rights you have, however, you must get more information. First, let me point out that health insurance provided by your employer is tied directly to your employment status. Therefore, when your employment ends, so does your coverage. This does not necessarily mean that the coverage terminates on the very day you lose your job, but it will not continue automatically. Normally, the employer pays health insurance premiums in advance on a monthly or quarterly basis, so it seems reasonable to believe that you would be covered to the end of the month.
The first piece of information you need is just that. Even though you received a notice informing you that your health insurance was terminated, you need to know the effective date of the termination. Call the insurance carrier, explain your situation, and ask what the actual termination date was. If you were not covered through the end of the month, you should ask why not. If your son's injury falls within the period of coverage, then his medical bills should be paid. In fact, many companies will pay for the continuing care associated with an injury that occurs during a period of coverage.

The second piece of important information you need is whether your employer COBRA for continuation insurance coverage. COBRA gives a former employee the right to continue group insurance coverage for up to 18 months as long as the person pays the premium, but it does not apply to all employers. Group health plans maintained by employers with 20 or more employees in the preceding year are required to offer the continuation coverage. Several states have passed laws that extend continuation coverage rights to employees of companies with even fewer than 20 workers and for periods longer than 18 months. COBRA continuation coverage is more expensive than the employee portion of the premium, but it can be less expensive than individual health coverage.

If you are eligible for COBRA, and your employer or health plan failed to notify you of your rights, you may have a complaint to file with the insurance department in your state. If COBRA applies, the employer and health plan will have to make coverage retroactive to the date of your termination, although you will have to pay the premiums.

If you are not eligible for COBRA, you may have another alternative. Employees who had 18 months of continuous coverage may be eligible for guaranteed-issue insurance in the non-group market that must also cover pre-existing conditions. If your coverage gap is less than 63 days, your state has a program that guarantees insurance to you without exclusions for pre-existing conditions. It would not pay for any medical bills you have before you were covered, but it would pay for new medical expenses incurred after the effective date.

So you have some phone calls to make. Your former employer can tell you whether COBRA applies to you. Your insurance company can tell you exactly when coverage ended, and why. The insurance department can confirm whether you are eligible for COBRA, and what mechanism is used in your state to provide guaranteed-issue insurance for eligible families. Finally, the health department can tell you whether there is any other public assistance program that might apply to you.