Health Insurance Question . . . Not Sure I Want To Ask (1 Viewer)

[Anarchy99]

Given the landscape on the boards when it comes to Obamacare, I am leery to bring this up. But I figured I would ask anyway.

My wife is the one that carries insurance in our household, and she just switched jobs. I have two kids from my first marriage, both of whom are in college. Her new employer offers a decent HMO type family plan, which would cover all of our kids for the same cost. When she was interviewing, she specifically asked if they covered stepchildren and they said yes. So far so good.

She recently started her new job and had to list off the pertinent information for everyone to be covered on the new company's insurance plan. Well, now there is a glitch. The company is now saying that they will cover BIOLOGICAL children of an employee until they are 26 (per the Obamacare mandate).

However, they are now saying that the Affordable Care Act only requires insurance companies to cover CHILDREN of employees up until age 26. According to them, there is nothing in the wording of the law that forces any policy to include STEP CHILDREN of an employee. As a courtesy, they have adopted a company policy that they will cover step children (even though they say they don't have to) until they are 18 years of age. Bottom line, they are now threatening to renege on their promise to provide health insurance for my kids.

They haven't flat out said they won't add them to our policy, but we have to request a case review and provide special circumstances as to why they should cover them. Apparently, promising to provide health insurance to everyone in our household as an offer of employment is not enough of a special circumstance.

With college set to start in a few weeks, we have to be able to show proof of insurance to the kids' respective colleges or they will automatically charge them each close to $2,500 to be added to their college's insurance plans . . . which would be mandatory and non-refundable. This also seems extreme, but apparently you have to be insured to start school.

Does anyone in the insurance industry know if the company can exclude step kids from a health insurance plan? Can they really only cover step children until they are 18 but "regular" kids until they are 26 and get away with it? How about the colleges . . . we could resolve the insurance coverage situation a day or two after class starts and they would charge us for an entire year? That also seems ridiculous.

 

[Obie Wan]

If your wife's employer won't pay for the insurance coverage directly, they should reimburse for the cost of college coverage

tough to get them to comply if the promise to cover the step-kids is not in writing, though

 

[trogg78]

This is a complicated situation with many different terms and parties involved. You should sue.

 

[fourd]

I don't believe there are any exceptions to the law allowing children to stay on the plan until 26, even for self-insured plans. And step children are considered children under the law.

 

[MAC_32]

Doesn't help your situation, but the college has its hands tied on health insurance. You're in or out week one, no in between. If they disclose in then they are on the hook for the bill no matter what. By them being in the kid is in too. College isn't going to eat that cost.

Stupid, but their hands are tied.

 

[heckmanm]

link

Relevant bit:

Dependent Coverage of Children Q14: Will a group health plan or issuer fail to satisfy section 2714 of the Public Health Service Act (PHS Act) and its implementing interim final regulations merely because it conditions health coverage on support, residency, or other dependency factors for individuals under age 26 who are not described in section 152(f)(1) of the Internal Revenue Code (Code)? (That section of the Code defines children to include only sons, daughters, stepchildren, adopted children (including children place for adoption), and foster children.)No. A plan or issuer does not fail to satisfy the requirements of PHS Act section 2714 or its implementing regulations because the plan limits health coverage for children until the child turns 26 to only those children who are described in section 152(f)(1) of the Code. For an individual not described in Code section 152(f)(1), such as a grandchild or niece, a plan may impose additional conditions on eligibility for health coverage, such as a condition that the individual be a dependent for income tax purposes.

So stepchildren are defined in 152(f)(1) as "children" and therefore are covered by the age 26 requirement.

 

[sbonomo]

was this addressed in her offer letter?

 

[Grace Under Pressure]

Clarifications in the Final Regulations. The final regulations make two important clarifications with regard to this dependent coverage:

• Employers may, but do not have to, extend dependent coverage to foster children and stepchildren; and
  
• Dependent coverage must be continued through the end of the month in which the dependent turns 26.
  

Dependent Child. Under the proposed rules, a dependent child included biological children, adopted children, foster children and stepchildren. Commenters asked that stepchildren and foster children be excluded from the definition, and these comments were accepted. As a result, the final regulations exclude foster children and stepchildren from the list of children required to be covered for purposes of the employer mandate. However, plans remain free to extend coverage to these children.

 

[Anarchy99]

Clarifications in the Final Regulations. The final regulations make two important clarifications with regard to this dependent coverage:

• Employers may, but do not have to, extend dependent coverage to foster children and stepchildren; and
• Dependent coverage must be continued through the end of the month in which the dependent turns 26.

Dependent Child. Under the proposed rules, a dependent child included biological children, adopted children, foster children and stepchildren. Commenters asked that stepchildren and foster children be excluded from the definition, and these comments were accepted. As a result, the final regulations exclude foster children and stepchildren from the list of children required to be covered for purposes of the employer mandate. However, plans remain free to extend coverage to these children.

So here is the part that confuses me. If stepchildren are considered children for health insurance policies, if we get a policy through the employer, can we just add the step kids through the insurance company? After all, it doesn't sound like the insurance company can exclude them as step children. According to the terms of the policy of the employer, adding kids to the policy adds an additional $0 per child to the cost of the plan, even if we had 20 kids.

 

[boots11234]

This is a complicated situation with many different terms and parties involved. You should sue.

Is this a Ned Altus?

 

[boots11234]

On a serious note my stepdaughter is covered under my Obama compliment plan. She's 23.

 

[matttyl]

Not that either of these should really matter, but....

What state is this?

How big of a company is it?

 

[Anarchy99]

Not that either of these should really matter, but....

What state is this?

How big of a company is it?

NH. Company has 9,000 employees in the U.S. and is based out of Missouri (if that matters).

 

[Foosball God]

Clarifications in the Final Regulations. The final regulations make two important clarifications with regard to this dependent coverage:

• Employers may, but do not have to, extend dependent coverage to foster children and stepchildren; and
• Dependent coverage must be continued through the end of the month in which the dependent turns 26.

Dependent Child. Under the proposed rules, a dependent child included biological children, adopted children, foster children and stepchildren. Commenters asked that stepchildren and foster children be excluded from the definition, and these comments were accepted. As a result, the final regulations exclude foster children and stepchildren from the list of children required to be covered for purposes of the employer mandate. However, plans remain free to extend coverage to these children.

So here is the part that confuses me. If stepchildren are considered children for health insurance policies, if we get a policy through the employer, can we just add the step kids through the insurance company? After all, it doesn't sound like the insurance company can exclude them as step children. According to the terms of the policy of the employer, adding kids to the policy adds an additional $0 per child to the cost of the plan, even if we had 20 kids.

The insurance company can allow for only certain relationship types to be covered on a single policy. Your employer may have selected a plan that specifically excluded step children and foster children. Regardless, I don't believe the insurance company would allow you to add your step children to your existing policy with your employer even if the plan technically allows for it. I'm sure the Insurance company would be happy to sell you a seperate plan for your two kids, but of course they would not fall under your family MOOPs and deductibles.

 

[cstu]

Clarifications in the Final Regulations. The final regulations make two important clarifications with regard to this dependent coverage:

• Employers may, but do not have to, extend dependent coverage to foster children and stepchildren; and
• Dependent coverage must be continued through the end of the month in which the dependent turns 26.

Dependent Child. Under the proposed rules, a dependent child included biological children, adopted children, foster children and stepchildren. Commenters asked that stepchildren and foster children be excluded from the definition, and these comments were accepted. As a result, the final regulations exclude foster children and stepchildren from the list of children required to be covered for purposes of the employer mandate. However, plans remain free to extend coverage to these children.

That is really ####ed up.

 

[matttyl]

Not that either of these should really matter, but....

What state is this?

How big of a company is it?

NH. Company has 9,000 employees in the U.S. and is based out of Missouri (if that matters).

A group that size I'm sure is on a "self-insured plan", and in many ways they get to make their own rules. Typically they design their plans to look like fully insured (ACA/Obamacare compliant ones), but not always. For instance they don't have to include alcohol and drug rehab benefits, or pediatric dental benefits if they don't want to; all of which is mandated to be included on fully insured plans.

If their policy doesn't cover step kids (and I don't really know why it wouldn't to be honest), I think that would have been their decision as the employer. Now if they said they would and are now backing off that claim, that's a different story.

 

[matttyl]

Clarifications in the Final Regulations. The final regulations make two important clarifications with regard to this dependent coverage:

• Employers may, but do not have to, extend dependent coverage to foster children and stepchildren; and
• Dependent coverage must be continued through the end of the month in which the dependent turns 26.

Dependent Child. Under the proposed rules, a dependent child included biological children, adopted children, foster children and stepchildren. Commenters asked that stepchildren and foster children be excluded from the definition, and these comments were accepted. As a result, the final regulations exclude foster children and stepchildren from the list of children required to be covered for purposes of the employer mandate. However, plans remain free to extend coverage to these children.

So here is the part that confuses me. If stepchildren are considered children for health insurance policies, if we get a policy through the employer, can we just add the step kids through the insurance company? After all, it doesn't sound like the insurance company can exclude them as step children. According to the terms of the policy of the employer, adding kids to the policy adds an additional $0 per child to the cost of the plan, even if we had 20 kids.

That is true for many group set ups as if you are a husband/wife/one kid or a husband/wife/10 kids you'd be a "family rate" either way. The rate is the same, but the risk is not. The insurance company would be on the hook for so many additional children.

When they made their rates initially, if they assumed that only biological children would be included maybe they assumed something like 1.8 children per family. If they assumed that biological kids as well as foster/step kids were all included, maybe that number would have been like 2.5 children per family - and the standard "family rate" would have been higher from the start for everyone enrolling as a family.

 

[Grace Under Pressure]

Given the landscape on the boards when it comes to Obamacare, I am leery to bring this up. But I figured I would ask anyway.

My wife is the one that carries insurance in our household, and she just switched jobs. I have two kids from my first marriage, both of whom are in college. Her new employer offers a decent HMO type family plan, which would cover all of our kids for the same cost. When she was interviewing, she specifically asked if they covered stepchildren and they said yes. So far so good.

She recently started her new job and had to list off the pertinent information for everyone to be covered on the new company's insurance plan. Well, now there is a glitch. The company is now saying that they will cover BIOLOGICAL children of an employee until they are 26 (per the Obamacare mandate).

However, they are now saying that the Affordable Care Act only requires insurance companies to cover CHILDREN of employees up until age 26. According to them, there is nothing in the wording of the law that forces any policy to include STEP CHILDREN of an employee. As a courtesy, they have adopted a company policy that they will cover step children (even though they say they don't have to) until they are 18 years of age. Bottom line, they are now threatening to renege on their promise to provide health insurance for my kids.

They haven't flat out said they won't add them to our policy, but we have to request a case review and provide special circumstances as to why they should cover them. Apparently, promising to provide health insurance to everyone in our household as an offer of employment is not enough of a special circumstance.

With college set to start in a few weeks, we have to be able to show proof of insurance to the kids' respective colleges or they will automatically charge them each close to $2,500 to be added to their college's insurance plans . . . which would be mandatory and non-refundable. This also seems extreme, but apparently you have to be insured to start school.

Does anyone in the insurance industry know if the company can exclude step kids from a health insurance plan? Can they really only cover step children until they are 18 but "regular" kids until they are 26 and get away with it? How about the colleges . . . we could resolve the insurance coverage situation a day or two after class starts and they would charge us for an entire year? That also seems ridiculous.

Whoever told your wife this should be the one that has to clarify or help rectify. Was it a hiring manager or someone from HR?

 

[sfflchamp]

I'm pretty sure this runs counter to NH law. It might be a good idea to ask Senator Jean Shaheen's office for help.

HB 330 revised the part of RSA Section 415:5 that defines a “dependent child” for purposes of group health insurance to now read as follows:


The term “dependent child” shall include a subscriber’s child by blood or by law, who is unmarried and one of the following:
(1) Under age 19.
(2) Under age 25 if the child is a full-time enrolled student at an educational institution.
(3) Under age 26, a resident of New Hampshire, and is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, church plan, or health benefits plan, or entitled to benefits under Title XVIII of the Social Security Act, Public Law 89-97, 42 U.S.C. section 1395 et seq.

 

[Cyclones]

I'm pretty sure this runs counter to NH law. It might be a good idea to ask Senator Jean Shaheen's office for help.

HB 330 revised the part of RSA Section 415:5 that defines a “dependent child” for purposes of group health insurance to now read as follows:


The term “dependent child” shall include a subscriber’s child by blood or by law, who is unmarried and one of the following:
(1) Under age 19.
(2) Under age 25 if the child is a full-time enrolled student at an educational institution.
(3) Under age 26, a resident of New Hampshire, and is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, church plan, or health benefits plan, or entitled to benefits under Title XVIII of the Social Security Act, Public Law 89-97, 42 U.S.C. section 1395 et seq.

What does the bolded mean? Does simply getting married to someone with kids make them your kids "by law," or would they have to be legally adopted by the non biological parent?

I have a 12 year old son that my ex-wife and I adopted when he was three days old, and a daughter with my current GF - she has a 17 year old son. If we get married, I don't think that automatically makes her son mine and my son hers "by law."

My insurance covers my son and daughter, obviously, but I don't think me marrying my GF would qualify her son for my insurance, or vice versa.

 

[matttyl]

My insurance covers my son and daughter, obviously, but I don't think me marrying my GF would qualify her son for my insurance, or vice versa.

I believe it would.

 

[Cyclones]

My insurance covers my son and daughter, obviously, but I don't think me marrying my GF would qualify her son for my insurance, or vice versa.

I believe it would.

That's interesting. May be time to think about getting hitched.

 

[matttyl]

My insurance covers my son and daughter, obviously, but I don't think me marrying my GF would qualify her son for my insurance, or vice versa.

I believe it would.

That's interesting. May be time to think about getting hitched.

Not sure that's the reason to get married.

I'm a health insurance agent, but mostly work in the individual and small group markets. Reading directly from an agent "underwriting guideline" booklet for small groups I have on my desk -

"An eligible dependent is defined as:

* The spouse of an eligible employee

*The employee's unmarried or married child under the age of 26 which includes:

1 the employee's newborn, natural child, legally adopted child, or child placed in the home for adoption

2 the employee's stepchild

3 any other child for whom the employee is the legal guardian or has court ordered custody

* The employee's child 26 years of age or older who is incapable of self-support and blah blah....

Anyway, since the OP is asking about a very large employer, they may be able to write their own rules and such about who is an who isn't eligible.

 

[Cyclones]

My insurance covers my son and daughter, obviously, but I don't think me marrying my GF would qualify her son for my insurance, or vice versa.

I believe it would.

That's interesting. May be time to think about getting hitched.

Not sure that's the reason to get married.

I'm a health insurance agent, but mostly work in the individual and small group markets. Reading directly from an agent "underwriting guideline" booklet for small groups I have on my desk -

"An eligible dependent is defined as:

* The spouse of an eligible employee

*The employee's unmarried or married child under the age of 26 which includes:

1 the employee's newborn, natural child, legally adopted child, or child placed in the home for adoption

2 the employee's stepchild

3 any other child for whom the employee is the legal guardian or has court ordered custody

* The employee's child 26 years of age or older who is incapable of self-support and blah blah....

Anyway, since the OP is asking about a very large employer, they may be able to write their own rules and such about who is an who isn't eligible.

LOL, good point matty, I was being somewhat tongue in cheek there, but I appreciate the info. I work for a company that does some TPA work and the insurance business is like the matrix to me. Each payer has different priorities, benefit matrices, fee schedules, etc. It's like playing friggin minesweeper.

 

[sfflchamp]

My wife works in HR in NH and agrees with me that stepkids should be covered under NH law. The insurance company has to register with the state in order to cover NH employees. Here is a link my wife found:

http://www.nh.gov/insurance/consumers/documents/healthmandates.pdf

 

[Anarchy99]

My wife works in HR in NH and agrees with me that stepkids should be covered under NH law. The insurance company has to register with the state in order to cover NH employees. Here is a link my wife found:

http://www.nh.gov/insurance/consumers/documents/healthmandates.pdf

My wife's former employee, also in NH, had their legal team research the step kid issue and they determined there are 1,001 loopholes that allow companies to not have to cover them. They chose to cover them anyway, but they insisted they had no legal mandate to have to do so.

We are still waiting to hear from the new employer whether they cover the step children or not. It sounds like they, too, are saying they don't have to cover them, but they are considering covering them anyway.