Insurance company failed to disclose coverage limitations on Marketplace plan details

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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

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 2 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).


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