Coordination of insurance benefits

[rbv1121]

What is the name of your state?Michigan

I have recently started a new position and the company has "Defensive Coordination of Benefits" Cluase. I have never heard of this. It states that if your spouse has the opportunity to take health Insurance, That they must do so as the primary for themselves. This effects me financially as my spouse can opt out and we receive a significant check. Here are my questions.

Is this defensive COB legal.

Am I required to provide my wifes occupation and benefits to my employer.

Can they seek my wifes occupation and benefits from her employer and any medical institution.

If they do seek this information, what are my recourse options.

Thank you for your help in this matter.

 

[Beth3]

Is this defensive COB legal. Yes - and quite commonplace.

Am I required to provide my wifes occupation and benefits to my employer. Unless you're prepared to lose your job over this, yes.

Can they seek my wifes occupation and benefits from her employer and any medical institution. From a medical institution, no. From her employer, yes.

If they do seek this information, what are my recourse options. Either provide it or opt to resign or be terminated.

The cost of providing group health insurance to employees and their dependents is staggering. Many employers now require that if an employee has a working spouse and the spouse's employer offers health insurance, that the spouse is ineligible for coverage on another employer's plan. Why should your employer pay for your wife's medical bills when she can get employer-provided coverage elsewhere?

P.S. While I've not heard this called "defensive" COB, this type of requirement for a working spouse has been around for at least 10 years.

 

[rbv1121]

Coordination of Benefits

Live in Michigan.

I undertstand all of this but would appreciate some feedback.

This policy in this case provides damages to my family effectively negating a benefit that would otherwise be available. Do you know of any cases involving the recouping of damages due to such a condition. Assuming that we agree to the COB clause, this will impact my family to the tune of 20,000 over the next 4 years.

Thank you for your time.

 

[Beth3]

You do not have a cause of action to bring against your employer. If they wish to mandate that working spouses obtain group health coverage through their employer, they may. If other employers wish to offer an incentive for employees to opt out of coverage, they may.

Each employer gets to do what they feel is in their best interests. Why do you think your wife's employer offers an incentive not to take their insurance plan? It's so some other employer will pay for her medical claims. Your employer doesn't care to do that.

If you don't care for the terms of your employment (i.e. your employer's policy on this) you are completely free to find employment elsewhere with a company that has no such requirement. It may well prove somewhat difficult though, as more and more employers are adopting this type of COB clause.