Being dropped from Insurance

[Tink11464]

Here is what it says in his handbook for insurance (exact wording):

Who is Eligible for Coverage:
* Spouse
* Children under 26 years of age, unless otherwise extended pursuant to applicable state or federal law, including:
* Newborn Children
* Stepchildren
* Children legally placed for adoption
* Legally adopted children and children for whom the employee or employee's spouse is the child's legal guardian


***NO definition of SPOUSE anywhere in the booklet or website for the Insurance Company***

 

[ecmst12]

Yep that's what I suggested. If the plan SPECIFICALLY EXCLUDES common law marriages regardless of whether they are legal or not, that would be one thing. But it may not.

 

[ecmst12]

What you have may not be the FULL policy document though.

 

[Tink11464]

I have the full 100 pages of the policy/book. That is the only section that speaks of eligible persons for the plan. The rest is about the plan, what's included, not included (a lot), and so on. But no definitions as to SPOUSE.

 

[Zigner]

Therefor, it should be recognized as such by the insurance company.

But the point, Zigner, is that it's not and they aren't required to.

And I don't believe that is correct (legally.) I don't think the policy EXCLUDES common-law spouses, and it would need to in this case.

OP - grab up a copy of your policy and check the definitions. We're all actually just playing the "I suppose" game here...

 

[Zigner]

Ok - last time and then I'm done beating this horse.

1. You aren't "legally" married as is universally defined and recognized. You are in a domestic partnership that is recognized by your State as a common law marriage. That's just not the same thing.

Beth - I respect you, I really do. But you're wrong on this one. In PA, our OP is MARRIED. Not a Domestic Partner...a WIFE. If the OP and her HUSBAND split, they will need to get a divorce.

2. Your common law husband signed you up for coverage on his employer's group health plan as his eligible dependent when you clearly didn't meet the definition of an eligible dependent in the Plan. (This is the critical point of this whole discussion.)

I agree - but I think your supposition is wrong about the definition of a spouse (and the OP has confirmed by belief)

3. For seven years the insurance company has been paying for your medical expenses when you weren't legally entitled to coverage.

You believe. (But are not correct)

4. While there was no intent to defaud, it was fraud. (Thankfully, the insurance carrier doesn't appear interested in pursuing that.)

False.

If you want all the rights and benefits that go along with being married, then you and your husband need to get married by a Justice of the Peace, a minister, or someone who has a license from the State to perform marriages. Then the officiant registers your marriage and you may subsequently obtain a copy of your registered marriage license. Until and unless you have a marriage license, the insurance carrier WILL NOT consider you to be an eligible dependent.

That is also incorrect.

 

[Tink11464]

i have it - - there is no definition anywhere in the 100 pages for SPOUSE. Nothing. I wish I could attach it

 

[Tink11464]

Zigner - I am running out now - - but I thank you for giving me hope - - I was so upset this morning. Now I amore determined to fight what I believe to be is right!! Thank you

 

[Zigner]

Zigner - I am running out now - - but I thank you for giving me hope - - I was so upset this morning. Now I amore determined to fight what I believe to be is right!! Thank you

Tink - I am STILL of the opinion that your BEST solution is to get this all paper-ized.

 

[ecmst12]

An officiant is NOT needed to get married in PA. Go Quakers.

 

[Beth3]

This debate is long past being worthwhile. The bottom line is that the insurance carrier has dropped the OP from coverage as the insurance carrier does not recognize a spouse as a common law wife or husband. We can debate this to hell freezes over as to what the carrier should do but the fact is this is what they're doing.

I've been handling group health benefits for 35 years and the only acceptable definition of spouse I've ever seen recognized by a carrier is one who is formally married (as in a marriage license has been registered and issued by the State.)

OP - you can spend many thousands of dollars suing the insurance company and see if a court decides in your favor, or you can spend $50 bucks and get married and have this problem resolved within a few days. Entirely up to you.

 

[Zigner]

This debate is long past being worthwhile. The bottom line is that the insurance carrier has dropped the OP from coverage...

No, they haven't Beth.

 

[Beth3]

therefore they will be dropping me from the insurance.

You're right - but they will be doing so imminently unless the OP can produce a marriage license.

 

[Zigner]

therefore they will be dropping me from the insurance.

You're right - but they will be doing so imminently unless the OP can produce a marriage license.

I believe that further on, the OP states that it's her employer saying this, not the insurance company.

 

[Beth3]

Doesn't matter. Just because the State has chosen to recognize common law marriages doesn't mean the employer has to.