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can medical be denied legally separated spouse?


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Where the plan terminates spousal eligibility at the point of legal separation (as opposed to requiring final divorce), the spouse loses eligibility at the point of the legal separation and must be removed at that point.  Loss of coverage based on legal separation or divorce are both COBRA qualifying events.

Note that not all married couples legally separate prior to a divorce, and a legal separation requires a court order (merely living apart is not “legally separated”).

Details here: https://www.theabdteam.com/blog/legal-separation-vs-divorce-2/

Here's the relevant cite:

Treas. Reg. §54.4980B-4, Q/A-1(b):

(b) An event satisfies this paragraph (b) if the event is any of the following—

(1) The death of a covered employee;

(2) The termination (other than by reason of the employee’s gross misconduct), or reduction of hours, of a covered employee’s employment;

(3) The divorce or legal separation of a covered employee from the employee’s spouse;

(4) A covered employee’s becoming entitled to Medicare benefits under Title XVIII of the Social Security Act (42 U.S.C. 1395-1395ggg);

(5) A dependent child’s ceasing to be a dependent child of a covered employee under the generally applicable requirements of the plan; or

(6) A proceeding in bankruptcy under Title 11 of the United States Code with respect to an employer from whose employment a covered employee retired at any time.

(c) An event satisfies this paragraph (c) if, under the terms of the group health plan, the event causes the covered employee, or the spouse or a dependent child of the covered employee, to lose coverage under the plan…

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