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Spousal surcharge North Dakota

Discussion in 'Health Insurance, HMO, HIPAA & Disability' started by Sandra Moore, Nov 27, 2019.

  1. Sandra Moore

    Sandra Moore Law Topic Starter New Member

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    I realize most of the posts are over a decade old but this is a new issue for us and until I found your site I could not find a clear answer on the legality of spousal surcharge.
    I am trying to find out if there are any laws/rules/guidelines that a company must follow regarding implementing this spousal surcharge?
    Here is our situation. My husband's insurance has always been a secondary insurance for me while my employer offered insurance has been my primary insurance. Due to my health, this had worked well for us until last year when they changed plans. My husband's benefits guides and open enrollment forms since 2016 have stated, "if your spouse is eligible for his/her employer's medical coverage, and he/she chooses not to enroll and subsequently enrolls in our medical plan you will be responsible for paying the spousal surcharge of an additional $150 per month."
    I completely understand, and do not blame, his company for attempting to keep costs down. With that statement in mind we continued to have me on his plan as a secondary insurance as I never refused my employer's offered insurance. Nothing was ever said until August 2018 when his HR person sent him an email letting him know that a spousal surcharge would start being deducted from his next check.
    We have been asking his HR person why for several months now, which has apparently gone up their corporate ladder, and no one can give us an answer, since their own wording states it would be imposed if I refused my employer's plan.
    I have discovered through your site (thank you very much) that it is legal but I fail to see how they can legally charge a surcharge when they word it that way. We never would have put me on his insurance if it had been worded correctly. My employer plan cost me $600 per year with my employer paying all deductibles and co-pays up to the first $5000. We pay $1200 a year just for me to be added to his insurance which has a $6000 per person deductible per year. On top of that his employer has been charging us an additional $1800 per year for this surcharge and cannot explain why. Due to the surcharge and the change in plans his company made last year it is absolutely absurd to be on his insurance under those circumstances and as I said before we never would have done that had it been worded correctly.
    Can they get away with this regardless of how they worded it? Do they have any accountability?
    Thank you very much
     
  2. cbg

    cbg Super Moderator

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    You are paying the surcharge for having their coverage. I agree that they did not word it particularly well, and it is POSSIBLE (not a slam dunk - do not for a minute imagine that this will be a slam dunk case in your favor) that the wording will benefit you for exactly as long as it take for them to reword it and get the change approved by the relevant stage agency. But the key here is not, your declining or not declining your employer's insurance; the key is your enrolling in theirs. Their intent, whether they stated it properly or not, is to create a financial incentive for you to enroll in your own employer's insurance AND NOT THEIRS. That you enrolled in both is an interesting question, but I can pretty much guarantee you that while you might possibly win the battle, ultimately you will lose the war. It would be quite easy for them to reword the relevant phrasing and while it might be a few months to get the change approved, I doubt you'd get more than a year tops before you'd end up having to pay the surcharge again, with no available loophole this time.
     
    hrforme likes this.

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