Stang v. Clifton Gunderson Health Care Plan

71 F. Supp. 2d 926, 1999 U.S. Dist. LEXIS 16467, 1999 WL 970935
CourtDistrict Court, W.D. Wisconsin
DecidedJuly 30, 1999
Docket98-C-0631-C
StatusPublished
Cited by7 cases

This text of 71 F. Supp. 2d 926 (Stang v. Clifton Gunderson Health Care Plan) is published on Counsel Stack Legal Research, covering District Court, W.D. Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Stang v. Clifton Gunderson Health Care Plan, 71 F. Supp. 2d 926, 1999 U.S. Dist. LEXIS 16467, 1999 WL 970935 (W.D. Wis. 1999).

Opinion

OPINION AND ORDER

CRABB, District Judge.

In this civil action for injunctive relief, plaintiff Paul D. Stang contends that his *928 employer’s health care plan, defendant Clifton Gunderson Health Care Plan, im-permissibly denied health care coverage to his dependent son under 29 U.S.C. § 1182(a)(1) (the nondiscrimination provision of the Health Insurance Portability and Accountability Act, codified as a provision of the Employment Retirement Income Security Act). The nondiscrimination provision prevents group health plans from denying enrollment to dependents because of medical history. The Health Insurance Portability and Accountability Act becomes effective for group health plans on the first day of the first plan year following June 30, 1997. At the heart of this case is whether the act applied to plaintiffs application for coverage effective January 1, 1998, and, if not, whether defendant should be estopped from denying coverage to plaintiffs son because it misled him into believing the act would apply at that time.

Jurisdiction is present. 28 U.S.C. § 1331; 29 U.S.C. § 1132(e)(1). Presently before the court are the parties’ cross motions for summary judgment. From the undisputed facts I find that the act became effective for defendant on February 1, 1998; therefore, the act did not apply to plaintiffs application for coverage effective January 1, 1998. Because I find that act did not apply to plaintiffs application for coverage effective January 1, 1998, and that defendant cannot be estopped from denying plaintiffs son health care coverage, defendant’s motion for summary judgment will be granted and plaintiffs will be denied. Because plaintiff cannot succeed on the merits of his claim, it-is a moot point whether he will likely suffer irreparable harm entitling him to injunctive relief.

From facts proposed by the parties, I find the following to be material and undisputed.

FACTS

Plaintiffs family consists of his wife Carol and three children. Plaintiffs son Evan was born in 1995 and suffers from a kidney disorder known as nephrotic syndrome. He has been seen by physicians and receives treatment with prescription drugs for this syndrome.

Until October 17, 1997, plaintiff was employed by DCA, Inc., in its Madison, Wisconsin office. While employed there, plaintiff and his family were covered by a group health plan maintained by DCA. At the same time, Carol was employed at Bank One Corporation, which also maintained a group health plan for its eligible employees. Under the Bank One health plan, eligible employees are provided an annual open enrollment opportunity with enrollment effective on January 1. Carol was eligible for family coverage under the plan, but did not elect such coverage because she and plaintiff preferred coverage under the DCA health plan.

While plaintiff was employed by DCA, it closed its Madison office and terminated his employment, effective October 17, 1997. Coverage under the DCA health plan was scheduled to end on that date, subject to the continuation coverage rules under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).

On October 20, 1997, plaintiff became employed at the Madison office of Clifton Gunderson L.L.C., a certified public accounting firm headquartered in Peoria, Illinois. Before working for Clifton Gun-derson, plaintiff had had fourteen years’ experience as a lawyer specializing in employee benefit trust administration and management and retirement plan sales and administration. In addition, plaintiff has been a chartered life underwriter since 1986.

Clifton Gunderson maintains a self-insured health benefit plan for its employees that is an employee welfare benefit plan as defined by 29 U.S.C. § 1002(1) and a group health plan as defined by § 1191b(a)(l). Clifton Gunderson is the named fiduciary of the plan in accordance with 29 U.S.C. § 1102(a)(1) and the administrator of the plan in accordance with § 1002(16)(A). At all times relevant to this dispute, certain underwriting and ad *929 ministrative services were provided to the plan by Employee Benefits Corporation, a division of John P. Pearl & Associates. The Clifton Gunderson plan document does not contain any provision defining the plan year end. However, the Summary Plan Document states that the plan year begins on February 1st. Plaintiff was given a copy of the Summary Plan Document.

Joanne Throndson, administrator of Clifton Gunderson’s Madison office, informed plaintiff that he could enroll himself and his family for coverage under the plan without being subject to medical underwriting if he did so within 30 days of hire. She gave plaintiff a package of plan enrollment documents that included a “Group Insurance Enrollment Form.” Between October 20, 1997, when he started work, and November 4, 1997, plaintiff had conversations with three members of Clifton Gunderson’s human resources department, Joyce King, Gina Harris and Teresa Speck, all of whom informed him that applications for coverage after the first thirty days of employment would be subject to medical underwriting.

Plaintiff and his wife discussed which health plan they should choose for coverage for themselves and their children for the period after October 31, 1997, the scheduled date of termination of coverage under the DCA health plan. The two options they discussed were (1) continuing coverage under the DCA plan for November and perhaps December, pursuant to the COBRA election to be made by plaintiff within the 60-day period ending December 31, and then coverage under Carol’s Bank One health plan as of January 1, 1998; or (2) coverage under plaintiffs Clifton Gunderson plan pursuant to an election by plaintiff within 30 days of hire. They decided upon the first option. On October 30, 1997, Carol telephoned the Bank One electronic enrollment system and electronically elected family coverage under the Bank One plan effective January 1, 1998.

In early November, Clifton Gunderson provided its employees with three documents pertaining to coverage under the Clifton Gunderson health plan. The first document was entitled “Important Information regarding the New Health Care Law and how it affects your enrollment and coverage under the Clifton Gunder-son Health Care Plan.” That document states: “Attached is an explanation of how the Health Insurance Portability and Accountability Act of 1996 (HIPAA) affects the Clifton Gunderson Health Care Plan. The law becomes effective for our plan on January 1, 1998.” The second document was a memorandum dated November 6, 1997 from Teresa Speck of the Clifton Gunderson human resources department in Peoria. That document contains the statement: “As you may already have heard, there is a new federal law that will affect the Clifton Gunder-son Health Care Plan effective January 1, 1998.

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Bluebook (online)
71 F. Supp. 2d 926, 1999 U.S. Dist. LEXIS 16467, 1999 WL 970935, Counsel Stack Legal Research, https://law.counselstack.com/opinion/stang-v-clifton-gunderson-health-care-plan-wiwd-1999.