Insurance company failed to disclose coverage limitations on Marketplace plan details

UPDATED: Oct 1, 2022

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Insurance company failed to disclose coverage limitations on Marketplace plan details

What is my legal recourse when a health insurance company fails to disclose
monetary limitations of their coverage until after the enrollment period is over?
I would not have purchased a plan that costs more than 100.00 a month more than
the previous plan, resulting in an extra cost of more than 1200.00 this would
cover services of up to 1050.00 per year. These coverage limitations for the
upgraded insurance were not provided to me at the time of purchase. This seems,
at the very least, deceptive if not fraudulent.

Asked on January 7, 2019 under Insurance Law, Indiana


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 3 years ago | Contributor

If you were not provided information as to the limitations, that may well have been fraud: a misrepresentation about a material or important fact, done to induce you to do business with them (i.e. buy the coverage). Fraud would provide a basis to do one or both of seek monetary compensation (e.g. the cost of any medical care you get which they do not cover but should have, had the coverage been what they led you to believe) and/or void the agreement and get out of it, so you can buy other insurance. The key is showing that this information was not provided to you at all (and not, for example, that it was there but in the "fine print" which you overlooked, since if provided to you, this was not fraud).

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

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