Work insurance - changing and dropping spouse

[cs1234]

Ohio

I work for a company based in Alabama, and I work in the Ohio branch. Recently we recieved a letter stating that as of Sep 1 all coverage for our spouses are being dropped if they qualify for medical insurance at their place of employement. Currently my wife and I are on her jobs medical insurance, but will be switching to mine since she is pregnant. Her insurance pays only 60% of all pregnancy things and mine covers it at 100% so switching is the obvious choice. Our open enrollment for insurance here is in 2 weeks, so we would have switched before the Sep date. Is it legal for them to terminate her insurance in the middle of her pregnancy? We will be canceling her current insurance after we switch to my works. This seems like something that would be highly illegal to invaladate someone's insurance in the middle of a life altering event such as pregnancy or serious injury. Can i get some knowledgable feedback on the situation?

Thanks,

[cbg]

There is no law that says if you are pregnant, you are exempt from eligiblity requirements.

The ONLY law regarding pregnancy as relates to employer sponsored insurance coverage, is that pregnancy cannot be considered a pre-existing condition if moving from one employer-sponsored plan to another. If spouses who are eligible for their own coverage are no longer considered covered dependents after a certain date, and your wife is eligible for her own coverage at her place of employment, then she is no longer a covered dependent after that date regardless of whether she is pregnant or not. Being pregnant does not entitle her to a benefit no other similarly situated dependent can receive.

[moburkes]

Originally Posted by cbg

There is no law that says if you are pregnant, you are exempt from eligiblity requirements.

The ONLY law regarding pregnancy as relates to employer sponsored insurance coverage, is that pregnancy cannot be considered a pre-existing condition if moving from one employer-sponsored plan to another. If spouses who are eligible for their own coverage are no longer considered covered dependents after a certain date, and your wife is eligible for her own coverage at her place of employment, then she is no longer a covered dependent after that date regardless of whether she is pregnant or not. Being pregnant does not entitle her to a benefit no other similarly situated dependent can receive.

So, then , can OP and his wife change to his insurance company, then get dropped, and pick hers back up immediately? That way she will be covered 100% for a few months, then back to 60%? Not that its a great idea, but an option, maybe.

[cbg]

If we're talking about Section 125 plans, you can't just drop and add at will. You can ONLY drop and add during your initial eligibility, during the 30 days following a qualifying event (losing coverage through no fault of your own is a qualifying event) or at open enrollment.

The very large majority of health insurance plans are Section 125 plans these days. If the employee's portion of the premiums are pre-tax, or if pre-tax is an option, then it's a Section 125 plan.

Losing coverage because she is no longer eligible on her husband's plan would be a qualifying event to join her own plan. But as long as she is an eligible employee for her own plan, then WHETHER OR NOT SHE IS ACTIVELY COVERED ON THAT PLAN she is not eligible to be on the husband's plan once the change in dependent eligibility goes into effect.

[moburkes]

Originally Posted by cbg

If we're talking about Section 125 plans, you can't just drop and add at will. You can ONLY drop and add during your initial eligibility, during the 30 days following a qualifying event (losing coverage through no fault of your own is a qualifying event) or at open enrollment.

The very large majority of health insurance plans are Section 125 plans these days. If the employee's portion of the premiums are pre-tax, or if pre-tax is an option, then it's a Section 125 plan.

Losing coverage because she is no longer eligible on her husband's plan would be a qualifying event to join her own plan. But as long as she is an eligible employee for her own plan, then WHETHER OR NOT SHE IS ACTIVELY COVERED ON THAT PLAN she is not eligible to be on the husband's plan once the change in dependent eligibility goes into effect.

Gotcha. I mis-read the original post. He said that they were both changing to his plan, but according to what you are saying, that's not even an option until open enrollment. I'm licensed to sell health insurance, but I've only sold 2 policies, and they were individual policies, which are MUCH easier to understand, IMO. Thanks!!!

[cs1234]

You are correct in saying that we were both going to switch to my plan (covers at 100%), but since they are pulling this mess over on us, we will probably just have to bite the bullet and eat the 40% that her current policy wont cover. I guess we could have her drop to part time and not be elegible for health insurance at her company, which will allow her to participate in my insurance.

Thanks all

[cbg]

You'd better check and see whether or not a voluntary drop to an ineligible status will count - sometimes it doesn't.