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Can Your Spouse Remove You from Her Health Insurance Coverage

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  • 04-04-2018, 10:01 PM
    WhoDonnit
    Can Your Spouse Remove You from Her Health Insurance Coverage
    My question involves insurance law for the state of: California

    Thank you in advance for any advice. I hope I am in the correct forum category. Last September my wife of 7 years got a new job after 2&1/2 years of being unemployed. In late October her company (a major nationwide corporation with offices in every state and thousands of employees) sent her home with forms for selecting benefits. Together we chose medical, dental, prescription and vision plans. They would become effective December 1st, after her 90 day probation period. Our cards came in the mail and I said "whoohoo" after not having coverage since she quit the last job. A few days later she informed me that she no longer wanted to be married and that she "wasn't going to cancel my insurance". We filed for divorce in early December, I agreed to keep paying her car insurance and her cell phone bill as I knew they were taking money from her check for my insurance coverage. I was under the impression that I would continue to have insurance until the divorce was final. I did not use the insurance in December as there were annual deductible amounts that would reset January 1st.

    She moved back in with her mother, we made our property and financial divisions and things were pretty much settled. I began to use the medical in January getting some lab work and a physical. I began to use the dental insurance as I needed some work. My dentist got pre-authorization from the insurance company for work to be done. I had some root planing procedures and paid my co-pay. I then had a crown procedure started three weeks ago.

    Yesterday I got on the phone in an attempt to schedule a vision appointment. They asked me which insurance I had and they logged into their portal for the insurance, VSP. They said "your not in here". I said well maybe it is under my wife's name. They said "she is in here with her spouse, but it is not you". They told me the name and year of birth and I said "that is my wife's 30 year old daughter who lives in Los Angeles", we are in Sacramento.

    Coincidentally yesterday was also my appointment to have the permanent crown installed. When I got to the dentist they informed me that my dental insurance denied my claims stating that I was no longer insured. I told them to hold onto the crown and re-schedule me for a week later while I figured out what was going on.

    I phoned the "Benefits Management" company of my wife's employer, each employee and each dependent has a representative at this company. I told my rep what was happening and they transferred me to the the dental insurance provider, VSP. The girl at VSP confirmed that my wife had recently taken me off and added her "new spouse" which is really her 30 year old daughter.

    Now, despite the fact that we only had a verbal agreement. I was under the impression that she could only remove me from the insurance during open enrollment or if she has a "life event". I believe that a divorce is a life event but only when the divorce is final, which isn't until middle of June. I can not believe that this large corporation allowed her to switch spouses without any documentation. I also don't believe that she can insure her 30 year old daughter as her spouse. I don't want to get her fired but it could happen. I think that the dental insurance company is now digging into it.

    I texted my wife and she denied making any changes. I stated that there is now way that two insurance providers would have the full name and DOB of the adult daughter without her writing on some forms. She still denied it. This morning she texted me and told me that she spent 30 minutes on the phone with human resources and that it would be "fixed" in 3 to 5 days.

    My concern is that the dental insurance company is telling me that I was not insured during the time of my procedure, although I have no idea as to the "effective dates" of this change. Is there anything I can do about this? I plan to see what will happen next week and have the dentist check for coverage again. I was hoping to use this insurance while I have it but the clock is ticking. Should I hire legal representation or am I jumping the gun?

    Thanks!
  • 04-04-2018, 10:47 PM
    adjusterjack
    Re: Can She Remove Me from Insurance Coverage
    What I am about to tell you is critically important.

    When you filed for divorce did your petition include the preliminary injunction?

    A preliminary injunction typically says (among other things):

    Quote:

    Do not remove, or cause to be removed, the other party or the minor children of the parties from any existing insurance coverage, including medical, hospital, dental, automobile and disability insurance. Both parties shall maintain all insurance coverage in full force and effect.
    If your divorce filing has one that says that then you can file a Motion for an Order to Show Cause Why she shouldn't be held in contempt and ask the court to order her to restore you to the insurance with no lapse in coverage and if that wasn't possible the court could order her to pay for anything for which you were not covered.

    So look very, very carefully at your petitions, responses and all other court papers.

    Unfortunately, if your divorce filing does not have that injunction then she might not have any obligation to continue you on her coverage.

    As for legal representation, you are getting divorced and your wife is already screwing you over. So, yes, I suggest that you do get yourself an attorney.
  • 04-04-2018, 11:19 PM
    WhoDonnit
    Re: Can She Remove Me from Insurance Coverage
    Ok, thank you for the advice. I will get out the paperwork and study it closely.
  • 04-05-2018, 09:00 AM
    cbg
    Re: Can She Remove Me from Insurance Coverage
    While if she is fraudulently listing her daughter as her spouse there is clearly something wrong, just be aware that not all employers permit employees to cover ex-spouses. Removing you *may* not be a choice, although listing an otherwise ineligible dependent child as a spouse is clearly out of order.

    And people wonder why some employers (including mine) ask for proof of relationship before enrolling dependents!
  • 04-05-2018, 10:18 AM
    PayrolGuy
    Re: Can She Remove Me from Insurance Coverage
    CBG. It isn't an ex-spouse yet. While divorce has been field for it has yet to be granted. I know of no employer or policy (and certainly not VSP) that requires a not-yet-ex spouse to be dropped.

    I call shenanigans on the dropping OP outside of the open enrollment and before the divorce. Not to mention that the OP should have been given COBRA notice if he was dropped by notifying the employer that the divorce was final.
  • 04-05-2018, 10:28 AM
    cbg
    Re: Can She Remove Me from Insurance Coverage
    True on the divorce, but we have no way of knowing when the employer's open enrollment period is. Not everyone has their plan year run January to December or July to June. I once had a client whose plan year began on August 7th.
  • 04-05-2018, 10:38 AM
    PayrolGuy
    Re: Can She Remove Me from Insurance Coverage
    Quote:

    Quoting cbg
    View Post
    True on the divorce, but we have no way of knowing when the employer's open enrollment period is. Not everyone has their plan year run January to December or July to June. I once had a client whose plan year began on August 7th.

    Yes but the OP wrote
    Quote:

    I was under the impression that she could only remove me from the insurance during open enrollment or if she has a "life event".
    that would seem to imply the open enrollment hasn't happened yet.
  • 04-05-2018, 10:41 AM
    hr for me
    Re: Can She Remove Me from Insurance Coverage
    I have to wonder if she didn't drop the OP and add the daughter during Open Enrollment as of 12/1. That's possible without a spouse knowing/signature in many companies.

    OP, was your name specifically on the new benefits card(s)? I know some benefit plans just show the employee's name, so it is possible it was just an assumption that she truly added you in the first place. Especially since it was just " a few days later" that it was decided to divorce. Hate to be cynical, but her getting a divorce wouldn't be a reason generally to add a dependent. So I suspect this all happened at Open Enrollment.
  • 04-05-2018, 11:22 AM
    cbg
    Re: Can She Remove Me from Insurance Coverage
    I don't think we can be sure that the spouse necessarily knows when Open Enrollment is. We don't require the spouse to sign anything - it could easily be done without their knowledge. I tend to think HR for Me is correct in the main.

    There's no question that there's shenanigans, as you put it. A 30 year old daughter is not an eligible dependent no matter how you slice it. But the OP is right that it has to be through OE or a life event. So how do you suggest it happened? Are you suggesting that the employer deliberately and maliciously colluded with the wife to drop her spouse and illegally add her daughter? If not, what's your suggestion as to a chain of events?
  • 04-05-2018, 12:34 PM
    PayrolGuy
    Re: Can She Remove Me from Insurance Coverage
    Reading the OPs post. I wonder if this VSP is an elective post tax benefit. If so there may be no restrictions on adds or drops. And it may have been done on the employer's DIY portal.

    But if the employer allowed a 30 year old daughter to be added a spouse there is no telling what else the allowed.
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