Working Spouse denial of PPO coverage

[Guest aweems]

Is it legal for a company to disallow particiation of spouse in PPO plans if they are eligible for a plan with the company they work for?

I began working for a company in March of 2000 and we got coverage under the PPO plan. My husband became employed in July and since my insurance was better we decided to stay with my coverage. He has to sign a waiver of coverage for his plan. Now the company I work for is saying that they will not cover spouses under the PPO plan however if we want to switch to the HMO they will cover them. I would like to know what our rights are.

[Guest Patricia Ibbs]

If the plan involved is a self-funded (uninsured) plan, I don't think there is anything you can do about the eligibility/enrollment rules you cited.

If the plan involved is insured, there may be some state statue against these rules. Contact 1) the employer; 2) the insurance company or 3) the state insurance commissioner.