Dependent Marriage triggers COBRA

[Guest RLT]

There is an employee whose son got married May 24. The son wants to cover himself and his spouse on the insurance through COBRA.

Blue Cross says that since the COBRA starts June 1 and the marriage was prior to this date, she is not eligible to be covered.

If that is the case, no spouse of a marrying dependent would ever qualify.

Does anyone care to comment on this? I will send an appeal to be reviewed by legal, but I'm not sure what my grounds for appeal would be yet.

[Guest taxesquire]

1st, I assume that what's going on is that the son was eligible to be on the plan as a dependent, but incurred a qualifying event on June 1 and elected individual COBRA coverage, effective as of June 1. He got married on May 24 and wants to add his spouse on the insurance through COBRA.

Would the spouse have been entitled to coverage if the son had not incurred a qualifying event?

Blue Cross' answer sounds strange. If they had simply said "spouses of dependents are not coverred under the policy," that would make sense to me. Otherwise, this is really a HIPAA special enrollment issue, not a strict COBRA issue. Technically, if the spouse would have been allowed to be coverred under the policy, as long as the plan was notified of the marriage by June 23, she would be entitled to coverage.

The next question (and I guess this is what I'd include in the appeal), is that I think HIPAA special enrollment applies to COBRA coverage, too, so the son should be able to add the spouse as long as the plan is notified by June 23, which it was. Please don't quote me on that - I haven't looked into it before - but on an appeal, that's the direction in which I'd head.

[Guest RLT]

That is correct, the son was an eligible covered dependent of the employee. He was married on May 24 and his COBRA started June 1.

The marriage was the qualifying event. The new spouse of the son would not be eligible in this plan since dependents can't be eligible if they are married.

I think your angle on the special enrollment would be our only hope. However, Blue Cross will contend that the marriage was prior to the effective date of his coverage. Hence, it didn't take place during COBRA and wouldn't qualify him for a special enrollment.

She is due in December and the open enrollment for this plan is Jan 1, so that angle won't work either.

[Guest taxesquire]

That the spouse would not be eligible will likely be a problem, but you may as well take a shot!!!

I also assume the spouse was uninsured at the time of the marriage?

There's no way they'll be able to get an individual policy to cover the pregnant spouse. If the appeal fails, the son/husand may want to consider (i) getting a job with healthcare benefits, or (ii) establishing a personal high deductible health plan that will just cover him, but then he can establish an HSA to pay for his spouse's healthcare needs on a pretax basis.

[Guest SHaddon]

Except in the case of a newborn or newly adopted child, in order to be eligible for COBRA an individual must be covered on the plan on the day immediately preceding the qualifying event. As this is not the case for the wife, she would not be eligible as a Qualified Beneficiary. However, the son may be able to add her as a dependent during the plans open enrollment, if the employer allows active employees to add dependents at open enrollment as well.

[Guest Guest99]

SHaddon is correct, the newly acquired spouse is not eligible for COBRA. Sorry.