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  1. #1
    Karynnd is offline Junior Member
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    Stepchild Health Insurance Laws

    What is the name of your state? Michigan

    I would like to know if my husband's employer can legally deny health insurance coverage for my 3 children from my previous marriage. The children live with me and they are all claimed as dependents on our taxes. We have other children both together and from my husband's previous marriage and his employer will cover all of those children, but not his stepchildren.

    The reason they are giving him is they want to reduce costs and they say this is 3 fewer people to cover. I thought family coverage was always just family coverage. Can his employer legally deny coverage to my children? I found a law from New York that this IS illegal to do in that state, but I'm having trouble finding a specific Michigan law. (The New York law says, "A family polcy shall prove that adopted children and stepchildren dependent upon the insured be eligible for coverage as the same basis as natural children". I can give the specific link if anyone wants it).

    Thanks for your help. I find this whole matter pretty upsetting.
  2. #2
    cbg
    cbg is offline Senior Member
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    If you are in Michigan, it doesn't matter what NY law says.

    Michigan law does not define what is considered a family member. That being the case, it's up to the eligibility requirements of the individual policy. If the policy list step children as eligible, then your husband's employer must cover your kids. If step children are not listed as eligible, then they can legally be denied coverage.
  3. #3
    Karynnd is offline Junior Member
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    Quote Originally Posted by cbg
    If you are in Michigan, it doesn't matter what NY law says.
    I was merely bringing this point up because this means it is possible for his employer's actions to be against the law.

    Quote Originally Posted by cbg
    Michigan law does not define what is considered a family member. That being the case, it's up to the eligibility requirements of the individual policy. If the policy list step children as eligible, then your husband's employer must cover your kids. If step children are not listed as eligible, then they can legally be denied coverage.
    How would I find out what the eligibility requirements of my husband's employer are? I tried calling Priority Health (his new insurer) and they told me I would need to speak to his office manager (who is his sister-in-law). Incidentally, his employer DID cover my children for the first 6 1/2 years that we were married so would we have any recourse due to them doing so for precidence?

    Thanks for the information.
  4. #4
    somarco is offline Member
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    If the group plan is fully insured, the coverage must comply with state law. You can believe a fully insured carrier is not going to make up their own rules.

    If the plan is self funded, they can define dependents any way they choose.

    It really doesn't matter what the prior carrier did. Your concern is with the current carrier who (apparently) chooses not to cover the step children.
  5. #5
    Karynnd is offline Junior Member
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    Can you tell me what the difference between a fully insured plan and a self-insured plan is?

    I know they now have Priority Health HMO. I read over what is says in his PH handbook and it just says eligible dependents are "dependent children" without any definition as to whether this includes stepchildren or not.
  6. #6
    cbg
    cbg is offline Senior Member
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    I was merely bringing this point up because this means it is possible for his employer's actions to be against the law.

    But in Michigan, it is NOT against the law. NY law is not binding on any but NY employers. The fact that NY law requires an employer to cover step children doesn't mean all states do.


    How would I find out what the eligibility requirements of my husband's employer are?


    YOU can't, unless they choose to tell you, which they needn't. Your husband would have to ask for a copy of the Summary Plan Description. That will tell him who can be considered an eligible dependent.

    Incidentally, his employer DID cover my children for the first 6 1/2 years that we were married so would we have any recourse due to them doing so for precidence?


    Not if they've changed the eligibility requirements.
  7. #7
    Karynnd is offline Junior Member
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    Quote Originally Posted by cbg
    How would I find out what the eligibility requirements of my husband's employer are? [/I]

    YOU can't, unless they choose to tell you, which they needn't. Your husband would have to ask for a copy of the Summary Plan Description. That will tell him who can be considered an eligible dependent.
    What is a "Summary Plan Description"? Is that something they have in their employee handbooks because I don't think my husband's employer HAS an employee handbook.

    Also, what is the difference between a fully insured plan and a self-insured plan?
  8. #8
    cbg
    cbg is offline Senior Member
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    No, a Summary Plan Description is not part of the employee handbook. It is a summary of the insurance plan, usually about 20-40 pages (the actual plan will run more like 200-400 pages) which summarizes (thus the name ) what is covered, who is eligible etc. He can obtain one by asking his human resources office. The law requires that if he requests one, it must be given to him. Caveat; if there actually has been a change to the SPD, they have some unbelievably long time, I think it's seven months, to update it.

    In your case it does not matter whether it is fully insured or self insured. While it is true that a fully insured plan must follow state law, the point I have been trying to get across to you is that under your state law is is legal to exclude stepchildren. Since in your state either a fully insured or a self insured plan can exclude stepchildren, and since the information as to whether it is fully insured or self-insured is not easy to get at the best of times, I wouldn't worry about it.

    I'll answer your question though. In a fully insured plan, the insurance company is the one who is paying for the claims. In a self-insured plan, the insurance company only administers the claims and the money to pay them is provided by the employer.

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