Spouse uses other health plan AND spouse's health plan

[NaiveOne]

My husband's employer writes its own health plan but Wellmark Blue Cross and Blue Shield of Iowa administers it. He is enrolled in the Family plan. My employer provides Wellmark Blue Cross and Blue Shield of Iowa and I am enrolled in the single plan. Other than small premium increases, both of our plans have remained consistent over the past 15 years.

Because my husband's plan has a co-pay for office visits and prescription drugs I have been using his insurance as my primary and my insurance as my secondary. Each of us pay a premium for our plan.

Based on 2011 changes to my husband's plan I would like to know if it is illegal for me to use two separate plans. What is new with the health plan in 2011 is $2,500 deductible for family, out of pocket maximum is $5,000, instead of co-pay there will be 20% coinsurance, and an additional $60 co-pay for Specialist Office Visit plus an annual premium increase of $108.45. The company will also charge a $35/month surcharge to those who choose to cover spouse on the company plan, if the spouse has coverage available through own employer but chooses not to enroll in that coverage. Based on the language in the form that must be completed and returned to his employer no later than December 13, 2010, there is no criteria from which to choose that addresses the spouse opting for double coverage. If we simply ignore the form the surcharge will be deducted [from paycheck on a pre-tax basis] starting January 1, 2011 The form also requests spouse name, spouse employer, and spouse employer phone # as well as spouse signature and date acknowledging disciplinary actions for false statements.
1. Is it illegal to be covered by two health insurance plans?
2. I am not an employee with my husband's company, why am I required to sign any form for his HR department?
3. What is meant by the statement, "If you or your spouse opts out of Company's Health Plan due to the availability of other coverage, you will not be allowed to enroll in Company's Health Plan again unless a HIPAA qualifying event occurs"?
4. Would it be uneithical to speak with my company's corporate attorney about this matter?

 

[army judge]

My husband's employer writes its own health plan but Wellmark Blue Cross and Blue Shield of Iowa administers it. He is enrolled in the Family plan. My employer provides Wellmark Blue Cross and Blue Shield of Iowa and I am enrolled in the single plan. Other than small premium increases, both of our plans have remained consistent over the past 15 years.

Because my husband's plan has a co-pay for office visits and prescription drugs I have been using his insurance as my primary and my insurance as my secondary. Each of us pay a premium for our plan.

Based on 2011 changes to my husband's plan I would like to know if it is illegal for me to use two separate plans. What is new with the health plan in 2011 is $2,500 deductible for family, out of pocket maximum is $5,000, instead of co-pay there will be 20% coinsurance, and an additional $60 co-pay for Specialist Office Visit plus an annual premium increase of $108.45. The company will also charge a $35/month surcharge to those who choose to cover spouse on the company plan, if the spouse has coverage available through own employer but chooses not to enroll in that coverage. Based on the language in the form that must be completed and returned to his employer no later than December 13, 2010, there is no criteria from which to choose that addresses the spouse opting for double coverage. If we simply ignore the form the surcharge will be deducted [from paycheck on a pre-tax basis] starting January 1, 2011 The form also requests spouse name, spouse employer, and spouse employer phone # as well as spouse signature and date acknowledging disciplinary actions for false statements.
1. Is it illegal to be covered by two health insurance plans?
2. I am not an employee with my husband's company, why am I required to sign any form for his HR department?
3. What is meant by the statement, "If you or your spouse opts out of Company's Health Plan due to the availability of other coverage, you will not be allowed to enroll in Company's Health Plan again unless a HIPAA qualifying event occurs"?
4. Would it be uneithical to speak with my company's corporate attorney about this matter?

No, one can usually carry a smany health insuranc eplans as they desire.
Who knows with Obama Care coming how that will change.
that could be why your husband's employer is requiring you to sign the statement.
That said, you can't be made to sign the document.
If you don't, they could choose to deny you coverage.
Under the new polan, you might be better off without it.

Your husband's employer won't allow their attorney to speak with you about this.
You can retain your own attorney to assist you with understanding the new requirements.
Or, you could have your husband seek clarification from his HR departnment.
After all, hubby is a grown man, and it is HIS employer.

 

[cbg]

Just to establish my credentials here, I have 30+ years experience administering employer sponsored group plans.

1.) No, it is not illegal to have double coverage. However, one thing you have been doing wrong is that you do not get to decide which plan to use as primary. It is not a choice. Your husband's plan is primary for him; your plan is primary for you; if you have any children the terms of the policies will determine which is primary for them. The usual method is for the parent whose birthday comes first in the year (not the parent who is older; the parent who has the birthday in February as opposed to the parent who has the birthday in October, for example) is to be primary, but that is not required by law and a policy COULD have another method. But as for you and your husband, it's not a choice. You don't get to decide that the plan with better benefits is primary for everyone. For this reason, while it is not illegal, it is rarely cost effective to have double coverage unless the secondary plan has significantly better coverage. When that is the case you submit to the primary plan first and then to the secondary carrier to pay on the balance; you don't arbitrarily decide to make the secondary plan primary. Nor is it your right to be covered under both plans if one plan has an exclusion for those with other coverage available.

2.) You are not REQUIRED to do so in the sense that anyone is standing with a gun to your head. However, they are not obligated by law (at least not yet) to provide coverage to dependents, and it is their right (assuming the plan document says so) to deny coverage to anyone who does not follow their rules. Their plan, their rules.

3.) Essentially it means that you are not considered an eligible dependent if you have access to coverage elsewhere. This IS legal and is becoming more common. IF you lose your access to other coverage you will then be eligible to access their plan again.

4.) No, it would not be unethical. But it would be pointless. They are not doing anything illegal and your company attorney is not going to be able to force your husband's company to cover you. Particularly when it comes out that you have been fraudulently (possibly unknowingly fraudulently, but fraudulently all the same) using his coverage as primary when it was not.