Getting married for health insurance coverage

[gmw101]

What is the name of your state? TX
Is it legal or would it be considered insurance fraud to marry someone for the purpose of gaining health insurance coverage? If you don't have health insurance or your insurance excludes certain procedures, and you marry someone in order to be added to their insurance to gain that coverage, is that legal?What is the name of your state?

 

[momm2500]

depending on the health insurance plan, the new person would be subject to pre-existing which means they might not have coverage for up to 1 year

 

[cbg]

Not all plans, particularly not all group plans, have pre-ex clauses.

It's not illegal. In fact, we get questions all the time from people who are convinced that they should be able to insure their live in boyfriend or girlfriend, and what we tell those people is if you want coverage for them, get married so they qualify.

Now, if you were entering into a "marriage of convenience" that served no purpose and was for NO other reason than to provide health insurance, yes, that might be considered fraudulent even though no law specifically prohibits it.

 

[J_en_A]

Be careful what you wish for!

I am not knowledgeable of the Texas laws but last year I married my best friend two weeks before I became eligible for my work's health insurance benefits so he could piggy back on my policy because he was about to be diagnosed with ALS. Just like everyone else who bought my plan he was subject to preexisting condition laws. My marriage and the health insurance was considered very legal in my state of Kansas.

I do hope you exercise extreme caution because this can bite you in the rear very badly if your marriage goes south and it turns into a He said She said battle. I would recommend a very detailed prenuptial agreement to protect you both financially. As well as a clear understanding to the status of your relationship pre and post marriage, expected financial and family contributions or reimbursements for insurance premiums, status on sexuality, and so on. Leave no stone unturned and get it all in writing if at all possible so nothing is left in question before you go through with it! The slightest misunderstanding can lead to volumes of frustration later on down the road. Unfortunately I speak from experience.

 

[ecmst12]

It's not fraud, it's legal. The state doesn't tell you WHO you can marry as long as (in most states) it's someone of the opposite sex who is not a first degree relative. The state doesn't care WHY you marry them, whether it's for love or money or health insurance. BUT that doesn't necessarily make it a good idea - tons of other legal stuff goes along with getting married, besides just health benefits. So make sure you consider all of that stuff before you go talking to the justice of the peace!

 

[cbg]

It's fine, as far as the government is concerned.

The insurance carrier might be a tad concerned about "buying" claims in a marriage done only as convenience.

 

[ecmst12]

Maybe, but 1) How would they know, and 2) They couldn't actually DO anything about it even if they did know. If the marriage is legal, and the plan says they have to provide coverage for spouses if elected by the employee, and the employee properly enrolled the spouse and is paying the required premium, then they can't deny coverage.

 

[mommyof4]

Marriage, at its true basic foundation, is a legal contract. There is no law or requirement that the two people actually marry for love. In fact, it is only a relatively recent development that we marry for love. Marriage was originally 'invented' (for lack of a better word) for legal exchanges of property, ensuring that the property and wealth would remain within the families, and purity of the hereditaryy line (again...ensuring that property remains within the family) Hence, the origin of the dowry. This practice still continues today, even here. Ever heard of the term 'gold digger'?

It's not illegal and it's not actually fraud. It is, however, a very perilous road you are considering. I echo the other poster's advice to have an iron clad prenup and a very clear understanding of requirements and expectations of the marriage you are contemplating.

 

[cbg]

Oh, I don't disagree with you, ecmst12, for the most part. But believe it or not, I have had a situation not exactly like this question but something similar. By a fluke the insurance company did find out and they were contemplating cancelling the entire group; they ended by requiring the repayment of claims on the fraudulently added member.