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  1. #1
    Join Date
    Nov 2009
    Posts
    9

    Default Health Plan Changes

    My question involves labor and employment law for the state of: Michigan

    My wife's employer is making changes to their health care plans and are stating that any employee that can be covered on their spouse's plan will not be able to get coverage anymore. Currently my wife has her plan as primary and my plan as secondary.

    To me this looks like an ERISA violation and that spousal coverage should have no bearing on what they can or can't offer.

  2. #2
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Health Plan Changes

    Are you certain that they are declining coverage for employees and not for the dependent spouses?

    It would not be a violation of ERISA to do it the way you describe as long as the eligibility requirements in the plan document specify, or are changed to specify, that only employees with no access to spousal coverage are eligible. However, it is far more common for the plan to exclude dependent spouses who have access to their own coverage, rather than to exclude the employees. It's not the first time I've seen exclusions of employees with spousal coverage access, but it's far more rare.

  3. #3
    Join Date
    Nov 2009
    Posts
    9

    Default Re: Health Plan Changes

    Yes, they are excluding coverage to employees not dependents. There are several employees in her the office that have spouses that have plans that they are secondary on that management has found out about. Currently there is nothing in writing that specifies that policy as the new changes are suppose to take effect Jan 01, 2010. My employer has the policy that if a spouses coverage through their employer costs more than $800 a year they can be primary on my coverage. To me it seems that they legally can't deny her coverage unless they cost share the premiums to everyone not just selective people.

  4. #4
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Health Plan Changes

    Well, it's rare, but as long as the appropriate changes to the plan document are made, it does not violate ERISA.

  5. #5
    Join Date
    Nov 2009
    Posts
    9

    Default Re: Health Plan Changes

    Sorry to beat a dead horse but below is the exact wording from my employers plan

    "To be covered by an XXX health plan, spouses or XXX recognized same-sex domestic partners of XXX employees who have access to coverage through their employer must purchase single coverage if his/her annual premium contribution toward that coverage is $850 or less."

    So basically they only way that can force her out is to make all employees in her classification pay annual premiums in excess of $850.

  6. #6
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,521

    Default Re: Health Plan Changes

    So if you have all the answers, why are you asking us?

    AS LONG AS THE PLAN DOCUMENT IS FOLLOWED, IT IS NOT AN ERISA VIOLATION.

    What's more, they are allowed to amend the plan document if they want to change the plan, and that is STILL not an ERISA violation.

    I don't know how to make it any more plain than that.

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