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Financial Issues This forum is for discussing any of the financial issues involved in your divorce.

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  #1  
Old 11-03-2013, 12:32 PM
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Margaret-Krupa Margaret-Krupa is offline
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Question Cut off from Extended Health Plan Benefits when on Disability

Hello Everyone,

First of all I would like to thank very much each one of you who will take their time to answer my question. I truly appreciate your time and effort.

I am separated since July, 2012. We were married for 25 years. Since 2006 I am receiving CPP Disability and Private Insurance (RCB) benefits. I have been diagnosed with depression and other mental disorders in 2006. Since 1993 I have been on my husband's Extended Health Benefit Plan from his workplaces. Before we separated he "promised" to me that he will never cut me off these benefits because he understands how important these are for me.

My medication cost is $400 per month, I use psychologist, accupuncurist, massage therapy for my mental issues, I need glasses, I have feet problems and need orthotics, I have very little teeth left and soon all of them need to be removed and I will need denture.

Three weeks ago my husband sent me a text message notifying me that he asked his employer to discontinue my extended health benefits as of November 1, 2013 (policy renewal date). As of this month I will not be able buy my medication because I simply cannot afford it. CPP disability and my private insurance do not cover the cost of medication. Trillium Plan is does not apply to me because of my income bracket.

We have two sons who are 19 and 20 and both are studing full time at college. Both boys are living with me. My ex is only paying the minimum amount (according to tables) for ONE of our sons ($290).

Please can anyone advise me if I can go to court and get an order to have my husband reinstate my benefits? What do I need to do if I have to go to court? No separation agreement has been signed. I did not file an Application for CHild Support yet. No other court action has been started. I applied for legal aid but they want to put a lien on my house. I ma looking at JusticeNet lawyers but even this will be difficult for me to afford. My mortgage is high and expenses with two adult sons at home are big too.

Thank you everyone.
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  #2  
Old 11-03-2013, 12:38 PM
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I feel for you. What are his reasons for taking you off his benefit plan? Is it his decision or is it a policy of the company? Did he have to pay to keep you on?

If your mortgage is high then its time to settle the house issue so you can get an apartment that will have less upkeep for you with your multiple medical issues. It would be less stress for you also.
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Old 11-03-2013, 01:40 PM
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Quote:
Originally Posted by Margaret-Krupa View Post
Hello Everyone,

First of all I would like to thank very much each one of you who will take their time to answer my question. I truly appreciate your time and effort.

I am separated since July, 2012. We were married for 25 years. Since 2006 I am receiving CPP Disability and Private Insurance (RCB) benefits. I have been diagnosed with depression and other mental disorders in 2006. Since 1993 I have been on my husband's Extended Health Benefit Plan from his workplaces. Before we separated he "promised" to me that he will never cut me off these benefits because he understands how important these are for me.

My medication cost is $400 per month, I use psychologist, accupuncurist, massage therapy for my mental issues, I need glasses, I have feet problems and need orthotics, I have very little teeth left and soon all of them need to be removed and I will need denture.

Three weeks ago my husband sent me a text message notifying me that he asked his employer to discontinue my extended health benefits as of November 1, 2013 (policy renewal date). As of this month I will not be able buy my medication because I simply cannot afford it. CPP disability and my private insurance do not cover the cost of medication. Trillium Plan is does not apply to me because of my income bracket.

We have two sons who are 19 and 20 and both are studing full time at college. Both boys are living with me. My ex is only paying the minimum amount (according to tables) for ONE of our sons ($290).

Please can anyone advise me if I can go to court and get an order to have my husband reinstate my benefits? What do I need to do if I have to go to court? No separation agreement has been signed. I did not file an Application for CHild Support yet. No other court action has been started. I applied for legal aid but they want to put a lien on my house. I ma looking at JusticeNet lawyers but even this will be difficult for me to afford. My mortgage is high and expenses with two adult sons at home are big too.

Thank you everyone.
1. If your mortgage is high then sell the house and get a place you CAN afford. If you can afford to live in a house you can afford everything else. It's not only mortgage, it's property taxes, house up keeping and maintenance costs. Selling your house will give you money to...

2. Buy your own coverage. Some plans are flexible for some sort of customization. Manulife has a couple (Flexcare, FollowMe, GWL, Blue Cross has some, etc.) I am sure your insurance broker will be more than glad to help you. If you don't have one and live in a GTA area, pm me and I'll be glad to help with a few names and telephone numbers.

3. Health benefits like massage, acupuncture, psychologists are never ever covered for $xxx A MONTH. This is a yearly limit. The meds is a different story.

The glasses or contacts are covered once a every 24 months and you don't necessary need new glasses every period. People are using it because they can and they want to not because they need it.

So I assume you are not telling us the whole story. I am telling you thins because I work in this business for many, many years and I know what I am talking about.

4. Your husband could sincerely promise you to keep you on the plan a year ago but it may be may meet someone and wants to put this person on his plan. Just so you know: he has every right to do so and if that's the case, you should be removed from the plan any time (12 months period co habitation applies, not only on the renewal date). Renewal date of the group policy has nothing to do with the employees being put on the plan or removed.

Also if he is paying for his H&D and there is a big difference in single and couple/family coverage, perhaps he doesn't want to pay more than he should any longer especially if at the renewal the monthly premiums sky rocketed (depends on the plan usage by ALL plan members). He has an option to keep you children on the plan after removing you as his dependents providing they are full time students of the approved college or university and no longer than age 24 (some plans 23 or 25).

5. At age 19 and 20 your sons each are able to get a part time job and chip in, helping their mother, especially if they are still living with her, going to the fridge, taking clean cloths from the shelf and whatever you help them with. I know kids of the financially strong parents that work since age 10.

6. Staying on your husband's plan depends on the conditions of this plan. If plan restricts plan participation to the first line of relatives (husband/fife (common law/same sex partners included or excluded) then he must go by what his plan says. I know some "friendly" divorcing folks just do not notify the plan administrators and in this case a divorced spouse can be on a plan for ages. If the divorce is more like an atomic war, then a spouse with the plan can delete any coverages he or she wants at any given time or the day the divorce is finalized. There is very little if anything another spouse can do about it from my experience in this area.

There are too many things that are unknown and a lawyer can advise your.

I know a few cases, when a husband just canceled the spouse's coverage once separation/divorce procedures have started. I don't know if the judges can force to reinstate a cancelled coverage, hope they can't.

In our case, the other spouse will be thrown away from the plan the next second the divorce is final, no notices, just boom, out of there, you piece of garbage. Bye-bye. If they wanted to stay on the coverage they should behave just a bit differently. And I can't wait for this moment to come.
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Old 11-03-2013, 01:42 PM
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Rules may vary from company to company, however my understanding is that he does not have an obligation to keep you on his plan unless this part of spousal support.

AFAIK company plans only allow one spouse. If he is co-habitating and/or planning to marry, this may be a reason why he wishes you off of the plan.

If you are on disability, my understanding is that ODSP would give you drug coverage, and private plans should provide coverage for other needs.
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Old 11-03-2013, 02:36 PM
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Actually, this might be worth verifying as I was told that I was obliged to keep ex on my insurance until the divorce.

You have been separated for over year, it might be time to start divorce procedure and get everything settle.
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Old 11-03-2013, 02:43 PM
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I was self-employed sole proprietor and was on my ex's plan, which was provided by her public sector employer, and very generous. She cut me off a few weeks after separation stating she was required to. It was a lie, of course. She was just being vindictive.

The judge didn't remark on it. I didn't make an issue of it, I just arranged my own coverage. AFAIK there is no "requirement" in law for a spouse to keep the other covered by the plan. As I said before, if there is an entitlement to support, this can be included in support.

If there is no entitlement to support, I don't see how it can be argued that coverage is "required" other than to be a decent human being.
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Old 11-03-2013, 03:12 PM
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Quote:
Originally Posted by Mess View Post
Rules may vary from company to company, however my understanding is that he does not have an obligation to keep you on his plan unless this part of spousal support.

AFAIK company plans only allow one spouse. If he is co-habitating and/or planning to marry, this may be a reason why he wishes you off of the plan.

If you are on disability, my understanding is that ODSP would give you drug coverage, and private plans should provide coverage for other needs.
His motive could simply be a change in his employment terms. Our company told us, with a little warning, that due to the high cost we would have to pay 25% across board on our health care premiums. If he cuts her out, that's a savings for him, especially if the system is priced by benefit use and she's a high user of benefits.
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Old 11-03-2013, 03:18 PM
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Unfortunately I've had a lot of experience in requiring drugs I couldn't afford and having no drug coverage.

If you are on CPP Disability, then you need to apply for ODB - Ontario Drug Benefits. If the drug isn't covered, ask your physician to complete exception forms, asking ODB to cover the drug.

Re-apply for Trillium now that you have no coverage. You may think you're income too high, but claim your dependent boys and forecast the cost of your drugs if they weren't covered.

Go through the courts and get your agreement enforced, or what you need to do. He can always pay the premiums of Blue Cross or a private insurer if ordered, or negotiate with his current insurer for costs outside of his employment coverage.

Appeal to your doctor. Tell them your situation. They'll help with forms etc. Contact, or have your doctor contact, the drug makers and ask for compassionate coverage, or whatever that manufacturer calls it. They have all sorts of outreach programs.
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Old 11-03-2013, 03:26 PM
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Quote:
Originally Posted by Mess View Post
I was self-employed sole proprietor and was on my ex's plan, which was provided by her public sector employer, and very generous. She cut me off a few weeks after separation stating she was required to. It was a lie, of course. She was just being vindictive.

The judge didn't remark on it. I didn't make an issue of it, I just arranged my own coverage. AFAIK there is no "requirement" in law for a spouse to keep the other covered by the plan. As I said before, if there is an entitlement to support, this can be included in support.

If there is no entitlement to support, I don't see how it can be argued that coverage is "required" other than to be a decent human being.
My ex did the same to me, cut me right off. I was self-employed, working part-time and doing some work sessional for the college. It was years before I had employment coverage again. And then I started having to pay for it ... LOL. Still cheaper than the drugs, etc.

The problem with securing coverage with pre-existing conditions in the free market, without a group insurance plan, is that it's hugely expensive. You'll be exempt from dental claims for a minimum of 6 months, yet have to pay the premium, and they can quickly disqualify you for any LTD, STD benefits based on medical history.

There's no requirement for anyone to cease their benefits for their covered spouse either. And doing so, without notice or reason is just vindictive and mean.
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Old 11-03-2013, 03:36 PM
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Quote:
Originally Posted by MS Mom View Post
Unfortunately I've had a lot of experience in requiring drugs I couldn't afford and having no drug coverage.

If you are on CPP Disability, then you need to apply for ODB - Ontario Drug Benefits. If the drug isn't covered, ask your physician to complete exception forms, asking ODB to cover the drug.

Re-apply for Trillium now that you have no coverage. You may think you're income too high, but claim your dependent boys and forecast the cost of your drugs if they weren't covered.

Go through the courts and get your agreement enforced, or what you need to do. He can always pay the premiums of Blue Cross or a private insurer if ordered, or negotiate with his current insurer for costs outside of his employment coverage.

Appeal to your doctor. Tell them your situation. They'll help with forms etc. Contact, or have your doctor contact, the drug makers and ask for compassionate coverage, or whatever that manufacturer calls it. They have all sorts of outreach programs.
the poster doesn't have an agreement to enforce. A "promise" isn't worth the paper its printed on.

to the OP tell your doctor to prescribe generic forms of your medications, usually they are cheaper. You have to figure out what to do to get your own coverage and not rely on your ex. There may be rules etc that he has to follow so in reality eventually you most likely would be cut off anyways.
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