Guest Greta Posted February 19, 2003 Posted February 19, 2003 I have an employee who is legally seperated but has a court order to continue coverage for his spouse. What are the rules for the employer as far as keeping or dropping coverage for his spouse in this situation? I don't want to do anything that would put either of us in legal hot water! Thanks, Greta
Sandra Pearce Posted February 19, 2003 Posted February 19, 2003 What does your plan document or policy say regarding dependent eligibility? Legal separation or divorce is a COBRA qualifying event. A court can order the employee to continue coverage for the spouse but cannot order the plan to provide coverage it would not otherwise. The spouse may be eligible for COBRA-continuation and the employee may have to pay for (provide) that coverage.
Kirk Maldonado Posted February 20, 2003 Posted February 20, 2003 My guess that the couple is not "legally separated." For that to occur, they need a court decree. Thus, they have to spend almost as much as to get a divorce, but they are still married after they get the court order. My friends who are domestic relations attorneys say it is incredibly rare to find a couple that is legally separated. In fact, some divorce attorneys have never seen one in their entire career. Kirk Maldonado
Guest b2kates Posted February 20, 2003 Posted February 20, 2003 Check with your counsel to see if it is a qualified medical support court order. QMSCO
mbozek Posted February 20, 2003 Posted February 20, 2003 Kirk: Legal separation is used by spouses in some states as a cheap alternative to divorce since alimony/support is permitted under a separation decree, separation orders are easier to draft and the parties do not need to prepare a property settlement or QDRO. The spouses just live apart and avoid the cost of paying to get a final divorce. mjb
Mary C Posted February 20, 2003 Posted February 20, 2003 QMCSO's are not applicable to spouse coverage - only dependent children. Massachusetts and Rhode Island do have laws that if its ordered in a divorce decree that the employee continue to cover the ex-spouse on the employer's plan, the employer must allow it. Coverage continues until the earlier of age 65, other coverage, the employee is no longer eligible or either party remarries.
Kirk Maldonado Posted February 21, 2003 Posted February 21, 2003 MBozek: Thanks for the clarification. It sounds like other states have much more flexible rules for legal separation than California. Kirk Maldonado
papogi Posted February 21, 2003 Posted February 21, 2003 MaryC, as a follow up to your post, are the laws you refer to enforced through the state insurance commision? Do they apply to ERISA-governed self-insured plans, as well? I'm just curious. I don't know anything about MA and RI laws.
SLuskin Posted February 21, 2003 Posted February 21, 2003 Every state has different regs on this. Florida has no legal separation, you are either married or divorced. Maryland requires 1 year of legal separation before a divorce will be granted.
mbozek Posted February 24, 2003 Posted February 24, 2003 P: Michigan also has a similar law. Under the precedents, the state laws are preempted if they apply to a self funded plan but are valid if the employee is covered under an insured plan since coverage for the ex-spouse is deemed a part of the insurance contract. Self funded plan case is Bergin v. Wausau ins. Co., 863 FSupp 34. The Insurance co case is Cellilli v. Cellilli, 939 F Supp 72. Both cases involved Mass Law. mjb
mbozek Posted February 26, 2003 Posted February 26, 2003 Does anyone have the cite to the RI law that mandates coverage for the expouse? mjb
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