Large Employer-based Health Insurance rules in California

[nearSacramento1]

Hi all. What is the rule in California for a person employed by a large company (in this case a large medical provider) who has employer based health insurance, and their covered spouse....when that couple divorces, what are the rules about coverage for the non-employed spouse? Is this a California law or can it vary based on the large employer's rules? Is there a way that an ex-non-employed spouse can retain coverage they had under the employed spouse's health insurance? Or never, unless its COBRA?

 

[cbg]

In all states, that is determined by the eligibility rules of the insurance policy in question. It's going to depend entirely on the employer.

 

[nearSacramento1]

Ok so large employers can make their own rules about what to do about ex-spouses being covered or not? It's not a state or federal law?

 

[cbg]

No. There is no state law, in any state, that says an ex-spouse has to be allowed continued coverage. There is no Federal law that says ex-spouses must be allowed continued coverage other than through COBRA. SOME large employers MAY allow a ex-spouse who is already covered on the plan to continue coverage after a divorce. However, other than COBRA there is no law anywhere in the US, no matter what state they are in, that guarantees them that right.

 

[Taxing Matters]

Ok so large employers can make their own rules about what to do about ex-spouses being covered or not? It's not a state or federal law?

Federal law does two things for the divorced spouse of the employee: (1) allows the divorced spouse get COBRA coverage if the employer is COBRA eligible (and a large employer would be) and (2) allows the divorced employee to get ACA marketplace insurance as a life change event within 60 days of the qualifying event (the divorce). Apart from that what the divorced spouse gets is determined by the policy. I don't think California imposes any additional requirements in this regard.

 

[nearSacramento1]

Ok right. What I'm wondering is is it possible that an ex-spouse can be covered in this manner (after being divorced for over three years), or is it impossible to be so (based on CA or federal laws). Sounds like it is possible if the employer provides for this possibility.

 

[cbg]

In 40 years of administering employer-sponsored health plans, I have never once seen or even heard of a plan that would allow an ex-spouse to be enrolled on a plan as a dependent. I have, on rare occasions, seen plans that, if the spouse was already covered at the time of the divorce, would allow the ex-spouse to continue existing coverage. While in the abstract it is possible that a large employer could conceivably allow for an ex-spouse to be enrolled three years after the divorce, the odds against it are astronomical. I can guarantee you that no Federal and no state law, in CA or any other state, provides for such an option.

 

[nearSacramento1]

Yes I think not as a dependent, but in some fashion, even if it was COBRA, to continue being on the employed spouse's large-employer coverage (we are talking a large medical provider as the employer like Kaiser, Sutter, Dignity, etc). Even if the employed spouse is paying out of pocket for the coverage premium. But when people talk about doing that it usually means COBRA. If it's something other than that, it's possible that the employed spouse in question is not actually legally divorced from the ex!

 

[cbg]

For health insurance purposes, "dependent" means "anyone who is eligible to be covered on the insurance and is not the employee/subscriber him/herself. It's got nothing to do with tax dependency.

Once more. With feeling. There is NO California law that entitles an ex-spouse to continue to be covered on the employed spouse's insurance. There is NO California law that entitles an ex-spouse to be enrolled on the employed spouse's insurance as a dependent, tax or otherwise, after the divorce is final.

There is NO Federal law that entitles an ex-spouse to continue to be covered on the employed spouse's insurance other than through COBRA. There is NO Federal law that entitles an ex-spouse to be enrolled on the employed spouse's insurance as a dependent, tax or otherwise, after the divorce is final.

There is NO law in any of the other 49 states or the District of Columbia that entitles an ex-spouse to continue to be covered on the employed spouse's insurance. There is NO law in any of the other 49 states or the District of Columbia that entitles an ex-spouse to be enrolled on the employed spouse's insurance as a dependent, tax or otherwise, after the divorce is final.

This is true regardless of the employer or the health carrier. There no is NO legal provision guaranteeing an ex-spouse coverage on the employed spouse's health plan no matter what size the employer is, what state they are in, what industry the employer is, or who the health insurance carrier is.

An employer may, if they choose to, permit such coverage as long as it is clearly spelled out in their coverage plan documents. I have yet to hear of any employer who had chosen to do so with the sole exception already listed above.

The reference to three years leads me to believe that COBRA was elected at the time of the divorce and is now up. If you are the employed spouse and you are required to provide coverage to your ex, you're going to have to find it other than through your employer. If you are the ex-spouse, what happens now depends on what was in the divorce order, but a court CANNOT order the employer to cover you outside of its own rules. And if you are the employer, you should already know what your plan document provides for but unless it expressly states that ex-spouses are eligible dependents, you not only need not but must not cover them.

I do this for a living. I've heard all the questions there are. If the answer is still not clear, then explain in detail what the situation is and I will answer it. But if you are looking for a legal loophole that will force the employer to provide coverage to the ex-spouse, there isn't one.

 

[nearSacramento1]

Got it. Thank you so much for your clarity! If the divorce decree stated the employed spouse needed to provide health insurance for the ex (who didn't work and was stay at home spouse) for X amount of time after COBRA ended or whatever was available through the employer, then I guess that is something that the two would have worked out...how this coverage was going to be achieved, like paying for private health insurance through the same health company so she could keep her docs. So I guess it depends on the divorce order...if coverage is happening it's likely because of that and the employed spouse is coughing up a bunch of money to purchase private insurance. Many thanks for your detailed response.

 

[Zigner]

If the divorce decree stated the employed spouse needed to provide health insurance for the ex (who didn't work and was stay at home spouse) for X amount of time after COBRA ended or whatever was available through the employer, then I guess that is something that the two would have worked out...

Based on this, I would say that, since nothing is available through the employer, the employed spouse has may have no further obligation beyond the expiration of COBRA coverage.

Who are YOU in this situation?

 

[cbg]

So, you're the employed spouse's new partner, are you?

 

[nearSacramento1]

Ding ding! LOL

Luckily, employed and with good coverage in my own right with no plans to not be. Divorce when one spouse has quit during the marriage to support the employed spouse is some STICKY STUFF!