Health Insurance Supplement

[Subandera]

What is the name of your state? Florida
I wasn't sure if this belonged here or in family law section. I am divorced, have 3 children. Their father and I have joint custody. I provide primary insurance on the children (Blue cross) I have a medical supplemental policy thru my employer. I enrolled in what they called a "family plan" so my now husband and also the kids are covered in addition to myself. My oldest child has a life threatening disease and requires frequent hospitalizations. I have never had trouble with claims before. Now the comapany is wanting to know if the child resides with me (like I said we have joint custody), if I am required by our divorce decree to provide insurance, if the child has medicaid (which I cannot answer in 100% certainty because I do not know what his father has done) and other questions. I have had this same policy and made premium payments for 4 or more years and never ever was questioned about anything. Can they for whatever reason refuse to pay? adn to they have right to ask all those questions? I am rather confused. I am the legal parent I pay premiums I do nto understadn what is happening here

 

[somarco]

Most plans follow the "birthday" rule where the elder parent is the one who is considered primary for insurance. In other words, if you have a group health plan and your ex has a group health plan, if your ex is older he is the one who is supposed to be carrying the coverage.

The divorce decree may override the birthday rule if it clearly defines who has custody, what their obligations are with regard to providing health care, etc.

The questions your carrier has asked are all legitimate. They have a right to know if they have actual responsibility for these claims.

You need to answer the questions if you want the future claims considered. Bear in mind if your carrier determines they are not (and have not been) liable, they will rescind coverage on the "illegal" dependents back to the original effective date with a full refund of premiums paid, less claims paid on the dependents.

You mention you are covering your husband under your plan. Is this a current husband or an ex?

 

[Subandera]

reply

I think you misunderstood some issues. First of all, your last question, the husband I have covered is my current husband Not my ex. In reply to your other questions, I am the eldest AND there was court order for me to provide PRIMARY health insurance for the children (IE Blue Cross) which I do. The company asking all the questions is a secondary supplement thru my employerthat I got primarily for myself and my current husband. But for him to be covered I had to get the "family" plan, and thus my children were covered. It is supposed ot be one of those policies that pays a percentage of bill directly to the policy holder to apply to whatever expenses he/she sees fit. I file on it when my son is in the hospital becasue where he has to go is over 5 hours away. It helps defer the costs of fuel, eating out while there, housing etc. They have never questioned anything about anything before. One of the questions they asked was where the child resided. We have JOINT custody, but either way what difference does it make? Also, tehy wanted to know if the child was covered by medicaid or similiar. That is question I cannot answer, I do not know what my ex has and has not done, I have received no notification from anyone that the child has medicaid, but once again, what difference does it make if I am paying premiums for a supplemental policy and have a claim shouldn't they pay? I just don't understand why there is a problem this time. Like I said before I have had this policy for years with no questions and no problems before. I was wondering if maybe my ex is trying to play dirty somehow... I am in middle of child support modification and since the address etc of the insurance co was in some of the forms I had to submit, maybe he is trying to do something for some reason to make things difficult? I certainly don't get rich off these claims, like I said the funds are used to reimburse myslef of out of pocket expenses for travel, housing , eating and other issues related to my son being ill which is what it was intended to be for in the first place

 

[somarco]

I am the eldest AND there was court order for me to provide PRIMARY health insurance for the children

Then you need to provide these documents to your carrier.

tehy wanted to know if the child was covered by medicaid or similiar. That is question I cannot answer

You need to get the answer if you want your claim to be considered.

It really doesnt matter how long you have had the policy, or what premiums you have paid. The carrier has a right to determine (at any time) what their liability is (if any).