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  • Medical Benefits through employer

    I haven't been on the forum in ages...lots of issues resolved, some still ongoing.

    One thing that has come up is the health benefit coverage my stbx has through his employer. Our separation agreement (as of September) states "Stbx shall maintain the children and (me) on his medical benefits plan for so long as it is available to him for their benefit."
    He's now claimed it has been cancelled (as of Dec 31 - with no notice) because he has not lived with me for over 1 year. Well - I expected him to drop me as soon as he moved in with a recent girlfriend. Divorce is not final but that's just a matter of time. And wanted to make sure I was covered so I have my own private health coverage.
    But my interpretation of this clause was that unless the employer removes coverage then he is to continue the current plan (or if he changes jobs etc) If it's "available" then it continues. So now the kids have no coverage. They both live with me.
    Youngest is 14 so this is only needed until he enters university and can be covered under a student plan. Eldest starts university in September.

    What can/should I do about this?

  • #2
    He should still be able to put the kids on his plan. Because he lives with his gf only she can be his "spouse" but kids dont matter. My partner has me on his benefits and his kids as well.

    Comment


    • #3
      Since you're only separated and the order state he must keep you on his plan, he must follow the rules. Once the divorce is officially pronounce, you are on your own. The children will remain on his medical and dental plans until they reach the age of 18 or are no longer at post-education and no longer considered children of marriage.

      Comment


      • #4
        I have asked him to provide documentation from his employer and/or insurance provider confirming cancellation and indicating reason why the policy has been cancelled. I assume if he lost his job that would be reason - but he hasn't. And I doubt the insurance provider just called him out of the blue and cancelled the kids coverage. His answer so far is "it's not available so I'm not responsible". I've never heard of an employment benefits plan just suddenly ending. This is a large employer so not a small company.

        rockscan - how long would you need to be living together to be considered "spouse" by the insurance company? My own private coverage wouldn't cover my bf if we moved in together until we were living at the same address for at least 12 months. Until then, we would still be considered "individuals" rather than "spouse" and the cost would be two policies.

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        • #5
          Once I moved in I was able to put him on my benefits. We had been living together for over a year when his benefits started so we were well within the timelines.

          Do you know the benefits company? You might be able to call and ask some general questions?

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          • #6
            Yes I know the company. I'm planning on calling them this week but they may not be able to provide answers so just getting an idea what others have experienced.
            I'm not concerned about my own benefits. I had purchased my own plan late in the fall as I thought (just based on his history) he would drop me without notice and before the order stated he was allowed. I had quickly looked through the provider website before the agreement was signed and I thought it said until "proof of divorce" so I thought he would be required to keep me on until it's all final.
            I'm surprised at him dropping the kids though. And I wonder if he really has - he may just not want to send my receipt into his provider and leave me with the bill. Either way - just need to know what's going on so I can plan moving forward.

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            • #7
              Hes still responsible for a portion of the expense even if he doesnt have them covered and if he makes more than you he pays more so hes pretty stupid to play this game.

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              • #8
                You're assuming he reimburses me for these expenses... That's the game.

                We're going to court on another item that absolutely needs to be resolved (he's more than 4 months over a court ordered deadline) and the medical expenses are going to be much higher (two dentist visits, 4 therapy sessions) between now and then. I take the kids to all their appointments so I'm the one that ends up paying and then chasing for his share...

                I guess I'll call the provider and see if they can tell me what the policy is regarding separation etc. Meanwhile he has some time - and notice from me - to get himself organized and hopefully do the right thing and either put the kids back on the plan and/or pay his share of these expenses (which is quite high).

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                • #9
                  Even if he puts the kids back in now these expenses won't be covered as they occurred before coverage. I work for a large corporation and in 2014 they redid their whole benefit coverage. We lost some big ticket items such as orthodontics. It was a cost savings measures. While we are still covered for drugs and other items our maximum amounts were lowered as well. I doubt a company cancelled all benefits but it could happen. Doesn't hurt to phone and find out

                  Sent from my SM-T560NU using Tapatalk

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                  • #10
                    ok a quick phone call answered the easiest questions. Separated spouses remain on benefits until divorce is final. New spouses cannot be added until they are living in same residence for 12 months. Children remain on plan until they are no longer dependents (including through post-secondary) regardless of which home they are living in.

                    He's done this against the court order.

                    So what do I do? I am going to court on another issue and can include this item - but other than making him looking like a lousy person in front of the court what can anyone possibly do about it?

                    Comment


                    • #11
                      Hello all!

                      I haven't been on the board for some time but check in once in a while. Here's an update to above and maybe you can weigh in on what (if anything) I can do about the latest antics.

                      stbx lost his job in December 2015 (it's was a part-time position and I suspect he was tired of working there while also self-employed). He never did give me any further confirmation that the benefits plan had been cancelled or why - I only gathered this from what the boys had told me.

                      So he set up a new private health savings plan for himself, his girlfriend (moved in a few months before), her child, and our boys as of May 2016. I was never informed. This was only discovered when the forensic accountant questioned the monthly payments found in his corporate books in May 2017. (it took nearly a year and two motions to get disclosure - and he still never fully completed the requirements)

                      So we had a TMC in early June and settled. (the trial was regarding his income determination). He agreed to provide the health coverage information as part of the settlement within one week.

                      I never received anything. So I emailed him early this week and asked for the information so that I could get the boys to their dentist before the end of summer. Eldest hasn't been to the dentist in over a year - and the youngest is overdue for a check up too.

                      So I received back a screenshot in photoshop that was the list of names of dependents - but all was blurred out and completely illegible. He also sent a travel benefits card. Nothing else. He refused to sent the booklet - so I don't even know what coverage they have. And said to give him the receipts once I pay and he'll send it on the provider. He also did this during our first year of separation but kept the money. Said he paid for the benefits so the money was his.

                      What can I do? Anyone else had to deal with this? We've had 6 months of intense lawyer fees dealing with two motions that he adjourned over and over again. Finally get to court and I win both motions - just awaiting decision on costs. So I'm fed up - thought this was all done with.

                      Advice appreciated.

                      Comment


                      • #12
                        Ugh, I feel your pain. Was the disclosure of Health Care benefits put into an Endorsement? I think you can move for a contempt of court. If it wasn't you could put in a motion that he disclose the Health Care coverage. Do you still have a lawyer? What does your lawyer say?

                        On another note. You mentioned a forensic accountant. Could you tell me how you got one and how much it costs?

                        Comment


                        • #13
                          Yes it was in the endorsement. The two lawyers submitted the draft order and we're waiting on it coming back from court.

                          The forensic accountant was pricey but needed. Stbx was adamant his income was half than it actually was so the expert report was needed to prep for trial - it also pressured him into getting his own expert who ultimately agreed with mine. Call around for quotes - mine quoted $5,000 - $10,000 and then trial at $5,000 per day. I paid the higher of the range because of the time it took to get the disclosure.

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                          • #14
                            ouch. Thank you

                            Comment


                            • #15
                              Originally posted by momof2teenboys View Post
                              Hello all!

                              I haven't been on the board for some time but check in once in a while. Here's an update to above and maybe you can weigh in on what (if anything) I can do about the latest antics.

                              stbx lost his job in December 2015 (it's was a part-time position and I suspect he was tired of working there while also self-employed). He never did give me any further confirmation that the benefits plan had been cancelled or why - I only gathered this from what the boys had told me.

                              So he set up a new private health savings plan for himself, his girlfriend (moved in a few months before), her child, and our boys as of May 2016. I was never informed. This was only discovered when the forensic accountant questioned the monthly payments found in his corporate books in May 2017. (it took nearly a year and two motions to get disclosure - and he still never fully completed the requirements)

                              So we had a TMC in early June and settled. (the trial was regarding his income determination). He agreed to provide the health coverage information as part of the settlement within one week.

                              I never received anything. So I emailed him early this week and asked for the information so that I could get the boys to their dentist before the end of summer. Eldest hasn't been to the dentist in over a year - and the youngest is overdue for a check up too.

                              So I received back a screenshot in photoshop that was the list of names of dependents - but all was blurred out and completely illegible. He also sent a travel benefits card. Nothing else. He refused to sent the booklet - so I don't even know what coverage they have. And said to give him the receipts once I pay and he'll send it on the provider. He also did this during our first year of separation but kept the money. Said he paid for the benefits so the money was his.

                              What can I do? Anyone else had to deal with this? We've had 6 months of intense lawyer fees dealing with two motions that he adjourned over and over again. Finally get to court and I win both motions - just awaiting decision on costs. So I'm fed up - thought this was all done with.

                              Advice appreciated.


                              Request the benefit account numbers, or a picture of his benefits card. That is all you will really need. You don't need a hard copy of anything. My husband just sent his ex a picture of his benefit card and she has been able to submit all dental or medical claims directly through the dentist or pharmacy. He never provided her a booklet, not that she asked but the first time you submit you will know basically the percentage covered.

                              Do you have benefits? If you do the reality is little will be submitted to his benefits anyways because yours will cover the majority. Most plans have an annual max of $1500 plus, I bet the dentist could find out once you have the account info. I wouldn't trust him to submit and pay you back so best you just get the numbers.


                              Sent from my iPhone using Tapatalk

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