| Message |
Author |
|
 Posted: Mon Mar 02, 2009 6:38 pm Post subject: Can someone have their exspouse |
|
|
Can someone have their exspouse (divorced since 1979) and her child (not the insured's child, nor adopted by the insured) on his medical coverage for 13 years after their divorce (thru 1992) while married (from 1986) to another person? Is this not fraud?
_________________
Register Now to have your Insurance queries solved. |
|
Guest
|
|
| Posted: Tue Mar 03, 2009 4:11 am Post subject: |
|
|
| It is fraud if the policy is through his employer. An ex-spouse can continue with the group health coverage for as long as thirty six months under the COBRA continuation act, or may receive the former spouse Federal health insurance if its dictated in the court order. However, he/she can't continue under your family enrollment. |
|
simon
Senior member
Joined: 28 Sep 2005
Posts: 550
93.55 Dollars($)
|
|
| Posted: Tue Mar 03, 2009 4:19 am Post subject: |
|
|
A dependant child may continue receiving the benefits till he/she turns 18 or remain a full-time student. You’re required to refer to the policy document for more information.
The family health insurance coverage document would spell out the eligible child criteria to receive the benefits under the plan. Adopted and/or stepchild also qualify as eligible child to receive coverage.
_________________
Register Now to have your Insurance queries solved. |
|
Amazon-sailor
Guest
|
|
| Posted: Tue Mar 03, 2009 1:18 pm Post subject: |
|
|
Clearly fraud
_________________
"Never, never be afraid to do what's right, especially if the well being of a person or animal is at stake. Society's punishments are small compared to the wounds we inflict on our soul when we look the other way." Martin Luther King Jr. |
|
Lori
Moderator
Joined: 10 Sep 2007
Posts: 8173
Location: Missouri
287.90 Dollars($)
|
|
| Posted: Fri Mar 06, 2009 10:24 am Post subject: |
|
|
Yes OP this is fraud. The policy holder should have informed his employer soon after the divorce if it is an employer provided medical coverage. After the policyholder gets a divorce, his ex wife can be on his policy only for the first few months and then needs to be removed or replaced (whichever is suitable).
_________________
AmPmInsure Blog |
|
sil
Community Writer
Joined: 30 Sep 2005
Posts: 483
89.47 Dollars($)
|
|
| Posted: Fri Mar 06, 2009 11:07 am Post subject: |
|
|
| The reason this sounds like fraud to me is because I am thinking of the guidelines from my own health insurance polisy. It states that the spouse resides with the insured. So I imagine there are different types of policies but some clearly have an age limit and other limitations that apply to them. I would get things straightened around before I found myself in trouble. |
|
fireyone
Senior member
Joined: 07 Jan 2008
Posts: 1993
2.31 Dollars($)
|
|
| Posted: Sun Mar 15, 2009 12:23 am Post subject: |
|
|
Believe it or not, I dealt with a case very similar in which the client was insured through Blue Cross Blue Shield of SC. His dependent (he was non-custodial parent) was insured on his medical coverage as was his ex-wife (6 years) as required my court order. He is remarried and his current wife maintains her own health policy.
He is an employee of the state and sat down with the benefits administrator and a rep from BCBS to see what the best way for him to remain compliant was. It was the benefits administrator's opinion that the state was willing to cover either the spouse or the ex-spouse (and that it would cost them the same regardless). The BCBS rep (who was from corporate, not an agent) stated that his court order laid it out specifically and that he would be allowed to continue to cover his ex-wife and his son on his health coverage...but that if he tried to add his current wife as a dependent he would be guilty of fraud.
As odd as it sounded to me, he had a letter from BCBS and from his employer to back up his story. What made it even more interesting was that his current wife pays an incredible amount for her own coverage...and they would probably save several thousand a year if they dropped the ex and purchased a policy for her! |
|
ChrisBantly
Senior member
Joined: 11 Mar 2009
Posts: 381
Location: Upstate SC
0.52 Dollars($)
|
|
| Posted: Sun Mar 15, 2009 1:16 pm Post subject: insurance |
|
|
| Quote: | The BCBS rep (who was from corporate, not an agent) stated that his court order laid it out specifically and that he would be allowed to continue to cover his ex-wife and his son on his health coverage...but that if he tried to add his current wife as a dependent he would be guilty of fraud.
|
WOW!! This situation seems like it's 'backwards'..ya know? I understand the Court Order thing, but,....not being able to add his CURRENT wife to the policy? Almost like a 'Catch 22'. |
|
sdchargersfan
Senior member
Joined: 21 Aug 2007
Posts: 2055
4.67 Dollars($)
|
|
| Posted: Sun Mar 15, 2009 3:54 pm Post subject: |
|
|
| Quote: | | as required my court order |
BIG difference....full compliance is required with court order..(although that is an odd one, never seen/heard of that one before  )...I don't think that's the case with the OP... 
_________________
"Never, never be afraid to do what's right, especially if the well being of a person or animal is at stake. Society's punishments are small compared to the wounds we inflict on our soul when we look the other way." Martin Luther King Jr. |
|
Lori
Moderator
Joined: 10 Sep 2007
Posts: 8173
Location: Missouri
287.90 Dollars($)
|
|
| Posted: Mon Mar 16, 2009 11:12 am Post subject: insurance |
|
|
| OK....the OP stated it's "required by a Court Order". However.......couldn't the MARRIED spouse be on the policy, as well? If the MARRIED spouse is 'added', how could this be fraud? I mean, having the EX on there is something beyond the Insurer's control. Hope my question is clear. |
|
sdchargersfan
Senior member
Joined: 21 Aug 2007
Posts: 2055
4.67 Dollars($)
|
|
| Posted: Mon Mar 16, 2009 11:57 am Post subject: |
|
|
| Quote: | | OK....the OP stated it's "required by a Court Order". |
no they didn't where did you get that impression? Christy was just giving an example of an odd situation she has seen...
You cannot (WITHOUT A COURT ORDER AND FULL AGREEMENT WITH THE CARRIER) keep your ex spouce and ex step kid on your group health plan, and NOT be committing fraud unless they KNOW it.
_________________
"Never, never be afraid to do what's right, especially if the well being of a person or animal is at stake. Society's punishments are small compared to the wounds we inflict on our soul when we look the other way." Martin Luther King Jr. |
|
Lori
Moderator
Joined: 10 Sep 2007
Posts: 8173
Location: Missouri
287.90 Dollars($)
|
|
