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DS: Employee health insurance & claiming eligibility

13 replies

Masie24 · 13/11/2019 23:35

DS is just about to complete 6 months in a company. Probationary interview, which should be fine, a few days after the completion of six month period. Employee dental and medical scheme will start on day he gets through end of probation period interview.

In the meantime, he has a booked dental appointment. Has had correspondence with HR whose responses to his questions about whether he'll be covered or not on day of appointment are rather vauge. My understanding is that he won't be covered for treatment before the start date of the scheme ie a few days later. But HR said have the treatment, keep the receipt and claim later. Though in next breath said that scheme starts day he gets through prob interview.

I would normally pay for the treatment and, now that insurance is about to kick in, would expect to get reimbursed by DS. I've told him that he needs to be very clear about whether or not he'll be covered before he's signed up to the scheme. He's reluctant to ask HR to clarify again. Or to phone them. He could defer his app by a few days - he really could. I'm feeling frankly ill about paying upfront for expensive treatment that may not, if I'm right, be covered under the scheme because it won't have started. I have a modest income and have shelled out so much so far on my kids - I think I'm being played the fool rather too often.

So, employees' health insurance. Surely claims can't be retrospective? Thanks for any advice.

OP posts:
GreenTulips · 13/11/2019 23:42

Does he think he needs treatment?
Does he have a NHS dentist?

The basics probably won’t be covered or an excess applied

DPotter · 13/11/2019 23:51

Be very careful here.
There is a thing in private medical insurance called a pre-existing condition. This is when a medical or dental condition exists before the insurance was taken out Usually such conditions are not covered. To give you an extreme example: you have been suffering from a cough for 2 months. You sign up to private medical insurance and the day after you go to the GP complaining of a cough for 2 months and ask for a private referral. After consultations and tests the results come back as lung cancer. The insurer will not pay out as the condition existed before you signed on the dotted even though you didn't have a formal diagnosis at the time of signing up.

Some, but by no means all, employee PMI schemes will allow pre-existing conditions for new employees, most will not. You are so right to be wary. If you son won't ask the HR dept (and he may need to ask to speak to the insurer as the HR may not know), then do not expect to be re-imbursed by PMI. At very minimum he needs to run this by the insurer, who may cover the cost of a consultation and require a dental health report before they agree or decline cover.

BritInUS1 · 13/11/2019 23:55

Just get him to move his appointment unless it is urgent, it's not worth the risk

Also, what if he doesn't pass his probation?

BritInUS1 · 13/11/2019 23:59

A couple of other points to note

  1. He might be able to use that dentist if he wants to claim through the insurance
  2. He might have to be a member of the scheme for a certain period of time before being able to claim
Masie24 · 14/11/2019 00:02

Thank you very much, all, for such speedy responses.

It's for a filling (which may be pre-existing in that sense) and a crown for an old root canal.

The thing that is concerning me is that the scheme will start early next week but the appointment is this week. I agree - he should phone the insurer and ask HR to be crystal clear on this matter.

He couldn't find a local NHS dentist but then maybe he/we didn't try hard enough. At the time, I had no idea he'd need this amount of treatment (I've paid hundreds up to now). Hopefully he'll be dentally fit after all this but this - the filling and crown is going to set me back £600.00. I'm sure that at least a portion would come back if only he'd wait a few days for the app. His reluctance to ask HR to clarify clealy is very upsetting. I'm strapped for cash and I wish he'd work with me on this one.

OP posts:
DPotter · 14/11/2019 00:08

I'm not sure you'll get anything back even if he does wait until after his probation is over. As both other PP have mentioned - there may be a qualifying period and a policy excess. And I would strong suspect both the filing and the crown for old root canal would be classed as pre-existing.
£600 for both is not a bad price however!
I really would assume that if you pay, you'll get nothing from the insurer.

Masie24 · 14/11/2019 00:17

DPotter - thank you. I think you could be right. (Though the company would pay the excess minus tax and NI in due course.)

I think that for the sake of a few days, DS absolutely has to find out if he can make a claim for treatment has took place before the scheme kicked in.

However, I accept that any claim may not be successful. And his health is my foremost priority in all of this. I just wish that he was prepared to get some clarity just in case at least one of the treatments gets through. I'm struggling to make ends meet.

OP posts:
DPotter · 14/11/2019 00:20

Off the subject of PMI - if your son is in a job which attracts PMI as a benefit, he's on a good wage - why are you paying for his dental work if you're financially struggling ?

Masie24 · 14/11/2019 00:30

DPotter - good point. He earns a low-ish graduate salary and pays a lot in rent (expensive area). I earn more (not much) but have significant outgoings as I have caring responsibilities for one of my other DCs. It's hard - I have two jobs and DH works part time. I think, if no claim can be persued, that I'll to reach some kind of accommodation with DS. Thank you - it's very hard.

OP posts:
Gemma2019 · 14/11/2019 00:58

The thing is, he hasn't tried hard enough to find an NHS dentist or been sensible and waited until he passed his probation before booking the appointment because he knows that it won't cost him anything either way. His treatment will either be reimbursed by his company or his mum, so no skin off his nose.

You really do not need to pay for dental treatment for your adult offspring! A loan maybe but they should be paying for it themselves. Time to cut off the gravy train.

GreenTulips · 14/11/2019 07:32

Why are you paying for his dental treatment if he’s a working adult?

Gazelda · 14/11/2019 07:42

He lives independently. Has a secure job (presuming he passes probation) and potential for PMI. I think it's time to tell him that he needs to cover his own medical costs.

HundredMilesAnHour · 14/11/2019 11:30

I agree with other posters in that he needs to be sorting all of this out for himself rather than getting his mummy to do it for him. Time to cut the apron strings.

He's also being an idiot booking an appt before his dental insurance kicks in. But I guess that's because he expects mummy to bail him out so he's not worse off either way. Stop mollycoddling him. Tell him you can't afford to pay for this and he needs to either pay himself or wait until his dental insurance is through. Or be treated on the NHS and pay those costs himself.

Also be aware that even if he passes his probation next week and is then covered by dental insurance, it can take a few weeks for his insurance to be set up and then there will probably be restrictions on the amount he's covered for (this can vary quite dramatically depending on the policy).

I really have no idea why you're even involved in this. He's not a child. Stop treating him like one.

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