Health Insurance Coverage for Separated Spouse?
November 20, 2012 3:55 PM Subscribe
I have a question regarding employer's health insurance coverage of a separated spouse. I understand that the information I might (hopefully) be given would be general and not necessarily pertinent in my case but since it's close to a holiday and I cannot get more specific information until next week, I'm hoping that some general info will calm the freakout I feel just around the corner.
posted by SweetTeaAndABiscuit to health & fitness (9 answers total)
This is in NC. There is no legal separation in NC, you are either married or divorced.
I stopped work in February of this year, first covered under short-term disability and then long-term disability. After six months on long-term disability I lost health insurance coverage through my employer (although I was offered and declined COBRA).
My husband and I have been separated for 10+ years but never filed for divorce for various reasons (first because we were raising a young child and wanted each other to receive life insurance benefits if one of us died, then just because of laziness more than anything). When I lost my health insurance through my (now previous) employer, my husband generously offered to carry me on a family plan policy through his employer. (He also carries our now-21-year-old son). We supplied his HR dept a letter from my former HR dept describing my "qualifying event." My former coverage ended on 08/31 and my new coverage under husband's policy began 09/01. Claims have been paid over the last couple of months with no apparent problems.
Last week my prescription refills were refused coverage. My husband learned that my coverage had been denied, ostensibly because we do not live together and are therefore considered separated. As I posted above, NC does not have a "legal separation," only married or divorced.
Today my husband was told to call the HR department again next week, after the holiday, to continue exploring the issue.
Are they allowed to deny me coverage simply because we live separately? Our legal status is married, we own a house jointly (which my husband lives in and pays the mortgage for) and our income tax status has been "married filing separately" for the 10+ years we have been separated.
I recently was awarded SSDI but will not be eligible for Medicare for 24 months. Because disability only pays 60% of my former salary, there is no way I could have afforded the COBRA insurance. My monthly healthcare costs are upwards of $6,000/month (I receive a monthly IV treatment that is $5,000 by itself). This has the potential to be a catastrophic problem for me if I truly lose this health insurance coverage.
To reiterate, I understand that no one can give me a firm and certain answer, I'm just looking for some sort of reassurance to get me through the next week or so until my husband can get more definitive information from his HR department. If we believe that they have unfairly denied my coverage, what would be the next step? Our state insurance commission? An attorney?
Thank you in advance for keeping me from losing my shit.