Questions & answers · Health insurance
My insurer cancelled my coverage back to the start date and wants the claims back. Can they do that?
Health insuranceDeniedChecked Nov 6, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: GovInfo · 45 CFR § 147.128 «Rules regarding rescissions» · paragraph (a)(1)–(2) View original ↗
In short
- A plan can't cancel your coverage back in time unless there was fraud or a lie on purpose.
- It must give at least 30 days' notice in writing.
- Ask in writing which fact it says was wrong, then appeal.
What this means
The federal rule says a group health plan or a health insurer must not rescind coverage once you are covered, unless you (or someone seeking coverage for you) did something that is fraud or made an intentional misrepresentation of material fact, as prohibited by the terms of the plan [1]. The rule defines a rescission as a cancellation or discontinuance of coverage that has retroactive effect, for example one that treats the policy as void from the time of enrollment [1]. A cancellation that works only going forward is not a rescission [1].
A cancellation that reaches back in time only because required premiums were not paid on time is also not a rescission [1]. Where a rescission is allowed, the plan must give at least 30 days' advance written notice to the people affected [1].
Your next step
If you got a cancellation letter that reaches back in time, ask in writing which fact the insurer says was misrepresented, and use the appeal steps in the letter. The sources above do not say how an insurer proves fraud in a particular case. The sources give 30 days' advance written notice where a rescission is allowed [1].
Check it yourself
Open GovInfo, 45 CFR § 147.128, at https://www.govinfo.gov/content/pkg/CFR-2025-title45-vol2/xml/CFR-2025-title45-vol2-sec147-128.xml and read the part quoted above. Your own plan or policy papers hold details these sources do not give: "Don't know yet" for your case.
Where this comes from (1)
[1] GovInfo · 45 CFR § 147.128 «Rules regarding rescissions» · paragraph (a)(1)–(2) · checked 2026-11-06
must not rescind coverage under the plan, or under the policy, certificate, or contract of insurance, with respect to an individual (including a group to which the individual belongs or family coverage in which the individual is included) once the individual is covered under the plan or coverage, unless the individual (or a person seeking coverage on behalf of the individual) performs an act, practice, or omission th…
How we found this
We matched your question to 1 official source, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.
What we don’t know yet
Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.
Every answer is checked against the official rule it quotes.
Information only — not legal advice. Your plan, insurer or agency decides.
This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.
Related answers
- Do I need prior authorization before going to the emergency room?
- Medicaid denied my claim saying I have other insurance, but I don't. What can I do?
- Medicare denied my "Welcome to Medicare" visit and I got a big bill. What can I do?
- My Medicaid application was denied. How long should a decision take, and how do I appeal?
Answer id CQ4304. Spotted an error? Tell us.