Denied Coverage Due to Spousal Coverage.

[sealjoy]

What is the name of your state? North Carolina.

I am trying to find out whether it is legal for my employer to deny me the right to have health benefits through the company program, because I am covered under my spouses health insurance at a different company. Other employees that don't have other coverage are allowed to participate and have the company pay 1/2 for the employee, but those with outside coverage can not participate because the company doesn't want to pay for it if they have coverage under their spouse.

Is that legal?

Thanks

 

[moburkes]

I don't think so. Insurance, if it is offered, must be made available to all eligible employees.

 

[cbg]

But, the eligibility requirements can include not having access to coverage elsewhere.

This is not illegal and is becoming more common.

 

[moburkes]

But, the eligibility requirements can include not having access to coverage elsewhere.

This is not illegal and is becoming more common.

But, I couldn't find that in writing to back me up, which is why I said what I did. What I wrote, I copied from the state's website. I couldn't find it on the dol.gov website either.

 

[ecmst12]

I've heard of denying coverage to SPOUSES who have coverage elsewhere but not employees...that's just insane.

 

[cbg]

It's more common to deny it to spouses, true. But I've heard of it both ways.

The law doesn't spell out what an employer may do, only what he either must, or must not do.

 

[sealjoy]

Thank you for your posts, I am still trying to locate the state laws.

As I can find out My Company does not have eligibility standards other than being part of the company for 90 days. This offering of benefits is new. Does the Company have to have it's eligibility standards written out so it is clear that those with current medical coverage are disqualified from participating in the Company medical coverage?

Thanks

Seal

 

[moburkes]

Thank you for your posts, I am still trying to locate the state laws.

As I can find out My Company does not have eligibility standards other than being part of the company for 90 days. This offering of benefits is new. Does the Company have to have it's eligibility standards written out so it is clear that those with current medical coverage are disqualified from participating in the Company medical coverage?

Thanks

Seal

No. Their standards to not have to be written out. They must, though, treat everyone the same. So, if you are not eligible because you have insurance elsewhere, then others who have insurance elsewhere must also be denied.

 

[ecmst12]

Yes, they DO have to be written out, but in the Plan Document(written up by the insurance company), not necessarily in anything from your employer.