If health insurance premiums were deducted but no health insurance has been provided, am I entitled to a refund?

I’ve had payroll deductions for health insurance for 8 months. I recently found out that I have never been enrolled in my company’s plan. I opted in during open enrollment, and shortly after I decided I no longer wanted the insurance, still during open enrollment. I called Blue Florida and cancelled. The accountant for my company said I should have contacted her instead and since I didn’t, I had to remain on the plan until next open enrollment. As it turns out, the insurance company cancelled my enrollment but she didn’t know so continued to take deductions. When discovered and brought to her attention, I was told I had to fill out an application to be added outside of open enrollment and I could not be refunded the almost $800 I had paid for coverage that I never received otherwise the company would face penalties for not complying with federal law. Am I entitled to a refund of the premiums paid during the time I did not have coverage?

Asked on June 24, 2017 under Employment Labor Law, Florida

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 3 years ago | Contributor

Yes, you are entitled to a refund: they are not allowed to take your money without providing the service or coverage for which you were paying. To keep your money without providing coverage is both a breach of contract (violation of their obligation to provide the coverage if you pay for it) and also unjust enrichment (being illegally benefited by taking money for provision of something of value without providing that thing). Unfortunately, you would have to sue to get your money. You would have to sue both the insurer and your employer, since one or another is at fault for this, but you do not know 100% whose fault it was: therefore you name both and let them fight out which of them is in fact responsible. Since lawsuits can involve cost and effort, and suing your employer is a drastic step, you have to carefully consider whether this is worth doing.


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