Duplicate Benefits

[rich7330]

What is the name of your state? Michigan

I am divorced and work for the same company as my ex. My 2 childeren are covered on her policy and I wanted to add them to mine. I'm doing this because we have a co-pay now and I would rather pay through my check than give my ex half of what it cost her. My divorce decree stated we both pay equally for health care. My employer is telling me they won't put the childeren on mine because it duplicates coverage and the insurer can't cordinate within the same policy. Can they deny me coverage for my childeren? Don't I have the right to the same coverage as anyone else regardless if the childeren are already on the policy under a different person.

 

[I AM ALWAYS LIABLE]

What is the name of your state? Michigan

I am divorced and work for the same company as my ex. My 2 childeren are covered on her policy and I wanted to add them to mine. I'm doing this because we have a co-pay now and I would rather pay through my check than give my ex half of what it cost her. My divorce decree stated we both pay equally for health care

My response:

Okay. Thanks for your thoughts, views, and opinions.

IAAL

 

[yomama]

Ummm, he very clearly asked if they could deny his children coverage. You have to read the post all the way to the end.

 

[OnlyOneVoice]

It may be possible to have the children dropped as your wife's dependents on the policy and switched to your dependent's on the policy.

But it still leaves the division of the co-pay and the premium split. Only it will be you who will need to be reimbursed instead of your ex.

This may not be an option depending on whether or not your company operates in an open season. Check with the benefits administrator at your company.

I'm not sure you can ever do it completely equitably, however if it is 2 children, you may just be able to transfer one child on as your dependent and the other left on your ex's.

I would ask if there are any other options and as I said start with the Benefits Administrator at your company.

 

[I AM ALWAYS LIABLE]

Ummm, he very clearly asked if they could deny his children coverage. You have to read the post all the way to the end.

My response:

I always do. But you don't. If you look carefully at my response, you'll notice that I quoted this writer's ORIGINAL post, which had NO questions. Then, after I posted, our writer edited his post - - realizing his mistake - - and added the balance you see now. You'll also notice that there is an "edited by" line in our writer's amended initial post.

IAAL

 

[rich7330]

But does or does not the employer have to offer the same benefits to ea. employee? Can't the childeren be under both? My other problem is my employer can't force my ex to release one to me. I'd rather pay my fair share to my employer than pay to subsidize my wife's because either way she has to pay family because she is remarried and claiming additional dependents

 

[cbg]

Your children are entitled to coverage. They have it. They are NOT entitled to duplicate coverage.

 

[rich7330]

unless we were on different policy #'s or with different carriers that would coordinate benefits??

 

[cbg]

If there were TWO policies and/or TWO carriers they could be covered on both, but coordination of benefits does not mean what a lot of people think it means. It does NOT mean that you will be guaranteed 100% of all bills paid.

The wording of the two policies would determine which of the two policies was primary and which was secondary. The majority of the time (but not 100% of the time) it is determined by the "birthday rule" - whichever parent has a birthday earlier in the year is primary. If your birthday is April 12 and the mother's birthday is September 3, your policy is primary. If her birthday is February 2 and yours is October 4, hers is primary.

The primary policy will receive the bills and pay whatever the terms of that policy dictates. Then you send the bills to the secondary carrier.

The secondary carrier would look at the policy and determine what they would pay IF they were primary. If they would have paid the same, or less, than the primary carrier, they then pay nothing. ONLY if they, had they been the primary carrier, would have paid MORE than the primary carrier did, would they owe anything, and then they would only owe the difference. So if the bill is for $100 and the primary carrier paid $80 but the secondary carrier, if they were primary, would have paid $90, they pay $10. Depending on the terms of the policies, you may or may not then owe the remaining $10.

There are NO circumstances in which an individual is entitled to be covered twice and receive double benefits on the same policy.

 

[rich7330]

As I said earlier I would like to insure one of the childeren so I can pay directly to my employer (tax free) but they said they cannot force her to drop one. We agreed in our divorce to split medical costs and prior to this year we did not have a co-pay. Do I need a court order to remedy this?

 

[cbg]

Probably.

 

[rich7330]

Thanks for the info