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Apr 17, 2008

  1. somarco
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    somarco That Medicare Guy

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    A lady (not a client) contacted me with the following scenario.

    I am divorced and have physical custody of our two daughters, but
    share joint custody with my ex-husband. In the divorce papers it
    states that our daughters will be covered under my new husband's
    health insurance policy. However, my ex just got a job where he can
    add our girls to his policy without paying any extra, so they will
    have double coverage. Which will be the primary policy, their
    biological father's, or their step-father's?


    I made a few calls, but did not get anything definitive. Thought I would throw it out here.

    Here is my qualified response.

    Thanks for writing.

    I really wish you hadn't asked that. There are no easy, or quick answers.

    My first impression is to tell you to leave well enough alone and do not put the girls under your ex's plan. There are too many potential pitfalls.

    Without getting in to too many details, here are some scenarios.

    The court decree supercedes the policies and your husband's plan pays first.

    The carriers can also do battle, each claiming the other is primary and both refuse to budge.

    The carriers could follow the birthday rule, whereby the insured with the first birthday of the year is primary, the other is secondary.

    Your ex's plan could say the girls are not eligible to be covered since the court decree specifies who has liability.

    This can be especially touchy if they learn, after they have paid claims, that they were not legally liable. They can then demand restitution for premiums paid (by your ex's employer) less any claims paid on their behalf.

    From my perspective, the least damage is to keep them off your ex's plan and do not provide double coverage. This may not be the answer you want but this is the best I can do under the circumstances.

    take care,

    Bob

    I have probably run into this before, but my brain is fried. Is there a definitive answer to her question?
     
    somarco, Apr 17, 2008
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  2. elisag2a
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    elisag2a Expert

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    I think you answered it as best you could with the info provided.
    I did work for an insurance company specifically in enrollment where these types of issues would come up. Sometimes the children we're dual covered by this insurance company (which the govt frowns upon especially with the same insurance company) and the issues they would look it would be month of birth of mother and father (if they are covered by different companies), also they would ask for a copy of the court order that states who has to provide coverage. And they would also ask who claims the children on their tax returns.

    Sometimes your better off just following the court order and not worrying about dual coverage.
     
    elisag2a, Apr 17, 2008
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  3. NewHealthStrategies
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    NewHealthStrategies Super Genius

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    I bow to Bob's expertise in prose and his ability to cover all the bases.....

    Your answer was the very best that could be had bar hiring an attorney.

    Good job, Bob............