Additional Health Insurance

[cbg]

Fine. If the majority of cases have been that way, then say that. Don't make a declarative statement that all cases are going to be that way. That can be very misleading to the poster.

Very little in insurance is absolute. Some of the law REGARDING insurance, such as COBRA, can be absolute. But too much of insurance is dependent on the specifics of the policy, whether it is individual or group, whether it is self-funded or fully insured. Even state law about insurance can be invalid depending on the funding of the policy.

I don't like absolute statements when they can't be supported. You said in an earlier post that I seem to be respected and trusted. Well, one of the reasons that is the case is that I am careful to point out exceptions when they exist, even if the exception is not what the poster wants to hear, because otherwise they end up believing they have rights and options that they don't have. And that does not help them in the long run, even if it makes them feel better in the short run.

Working in the medical billing department of a hospital and taking seminars on insurance coverage and COB's is not the same as working directly with the insurance and the insured. You've made some valuable contributions to some posts but I'm not going to tell you how to answer a question about medical billing; I expect you not to tell me how an insurance policy works. Okay?

 

[somarco]

Ablessin -

I certainly was not trying to pick a fight, or play one-up. Just addressing a "missing piece" in that many insured plans (group or invididual) will not extend coverage to a dependent that does not reside in the household of the covered participant and/or where the covered participant does not have custody of the dependent.

take care,

 

[ablessin]

Somarco,
no need to apologize.

In no way was I telling anyone how to compose a post.
I work directly with insurance carriers for 40 hours a week and I do contact member's (patients) as well for COB issues.

If it's court ordered, in all the cases I have seen, and also personally experienced, it doesn't matter where the children live. My fience carries his kids and they live with their mother (court ordered) I carry my son, and although not court ordered, my divorce decree states I agreed to carry the cost of insuring our son because my policy premium was cheaper than my ex's is/was.
I don't know how much laws vary from state to state, but in my section of the world, I have posted what I know . It does depend on how court orders are written, and if the parents can work things out, I have seen cases of court ordered insurance not held because between the parents, they agreed on something else!!!!!! All I can say to that is - if it works go with it - but if anything should ever happen, you're caught in a case of defying a court order.

At any rate, best of luck to the OP - I am sure they are confused as they were when they posted the question to begin with.

 

[somarco]

You (and your fiancee) might want to read your policy definitions. Several carriers in GA (my world) have been conducing audits to determine if they are covering illegal dependents (by comparing to contractual definitions).

A major employer just completed an audit and found over 7,000 illegal dependents . . . which were promptly booted off the plan. Court orders over who must cover the dependents has no bearing on the contractual definitions in employer health plans. As stated before, many plans (here at least) state that you must have custody/guardianship AND the dependent must reside in your household.

For what its worth, that employer will save over $13,000,000 in associated claim costs by taking those illegal dependents off the plan.

The time to find out if your dependents are illegal is before a claim.

 

[ablessin]

Then the courts ought to stop ordering parents to cover the kids then! In a perfect world (what is that?) - you know? There are thousands of cases like that - where (say) the father is court ordered to carry the kids, and the kids live with mom.
If it's fraudelent for the father to carry the kids, then the courts should not be placing the order to begin with....... it apparently is causing some (or could cause) major problems!

Well, we can check, because his kids live with their mom, but he was court ordered to provide the insurance for the kids......... seems like what the courts maybe should be saying, is the primary parent covers the kids and then the other parent would pitch in a percentage of the premium - that would avoid these audits and such!!

Thank you for the advice!!!!

 

[somarco]

You seem to be having some difficulty in separating parental responsibility and actions in a civil courtroom from benefits provided by an employer.

There is no fraud in covering children that are legitimate dependents under an insurance contract. What part of this statement are you finding difficult to grasp?

Civil (or family) courts have no jurisdiction in requiring employers to provide health insurance, nor do they have the right to dictate to an employer (or carrier for that matter) who is eligible for coverage.

I merely offered information that may or may not be valid in your situation. What you do with the information is clearly your business.

For what its worth, I have several clients that are covering children under individual policies that are comparable to group health insurance but much more cost efficient. Just this week I covered 2 children for $140 a month and provided benefits comparable to their group plan. The father was paying over $300 a month to cover his children and considered it wonderful I could help him save money.

You are welcome . . .

 

[cbg]

BTW, since this conversation appears to be continuing, both when I was working for the insurance carrier, and as an HR manager, I had employees inform me that I HAD to allow them to add a dependent to the coverage because they had a divorce decree or a court order saying they have to provide coverage.

Unless the employee was within 30 days of the finalization of the divorce (which opens a SHORT window that allows changes to dependent coverage), my response was always the same: "That court order/divorce decree is binding on you but it is not binding on the employer or the insurance carrier. We cannot be forced to violate the law (Section 125) because of your personal situation. When open enrollment comes along, you can add the dependent then, assuming that your dependent qualifies for coverage in the first place. Until then, you will need to find short term, individual coverage to take care of your dependent."

In EACH AND EVERY CASE that was upheld. We were NEVER required to add a dependent at a time when the plan did not allow for dependents to be added, and we were NEVER required to add a dependent who did not qualify for coverage under the plan, regardless of whether there was a court order or not.

 

[somarco]

For what it's worth, I thought the thread was dead a long time ago but apparently I (we) were wrong.

Thanks for the support. Some folks just dont like the answer they get. Sure would make my life a lot simpler if . . .