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Boyfriend still has ex on insurance..

post #1 of 15
Thread Starter 

My boyfriend and I live together. Collectively we have 3 kids (2 are his and exes and 1 is mine.) I have been with him for a year and 3 months. Both of us knew immediately that we were it for each other. Everything has been pretty wonderful this last year and 3 months. There have been a couple of minor issues, but nothing that has made us really even have an actual fight. I am worried this might...


Here's our background... Both of us work. We live together (as of our year anniversary,) and we intend on marrying eventually. Yes, it has been discussed. We split bills completely. There isn't "his" money or "my" money. It's all ours. We raise kids together (my son's father died and he has taken on the father role. I am around his kids as much as he is- which is literally every other day.)


Now, as for his ex wife.. She collects disability for having anxiety. While I don't doubt that this is a legitimate issue, it is not as debilitating as it used to be- but that is an entirely different matter. She also receives $800 a month in child support for 2 kids. So, collectively she gets $2,000 a month with disability and child support.


Now, boyfriend and ex have been officially divorced since May of this year (separated for 3 years.) However, she has been on his insurance the entire time since. Which, I wasn't bothered by, until I moved in and (unrelated) lost my health insurance. Now, because WE are paying bills, we raise kids and are essentially a family, minus marriage (which obviously i do not think you have to be married to be a family,) I have an issue with this. I do not think that it is okay that he still pays her insurance- it's $100 a month- especially because it is insurance fraud. He says he doesn't want to be an asshole. Correct me if I'm wrong, but if you are on disability, aren't you qualified for medicaid? She can get off her butt and go sign up for medicaid. She is no longer his wife and he doesn't need to pay her insurance anymore- it is not a requirement of their divorce. Excuse me, we don't need to pay her insurance. She has the ability to receive medicaid.. I don't. We could be using that money to pay for my insurance, but because we aren't.. we basically cannot afford insurance for me. This $100 is on top of the $800 he pays in child support. 


Am I in the wrong here? Does anyone think I am being selfish? This is illegal also and can't he get into trouble for insurance fraud?? I am so frustrated and have said things to him multiple times, but never so detailed as on here... I am going to.. I just want to vent and also get others opinions also. Please, help! 

post #2 of 15

Hi there Jess. People on SSDI do qualify for insurance, but it depends on their individual situation whether that insurance is Medicaid or Medicare. Medicare is typically for people over 65 and certain disabled individuals under 65. 




There are some situations in which a patient needs to access available insurance first before dipping into Medicare, and Medicare doesn't always pay a good rate; not all doctors accept medicare. I am just throwing out possible reasons why she might wish to continue on the insurance. Also you don't have to apply for it separately--once you are on disability it is part of your package.


So I am not completely sure what is going on with your sweetie's ex, but it sounds like a relationship hot potato and could be a sign of more complex issues.

post #3 of 15

Without a lot more detail on the terms of the insurance policy, and your boyfriend's communications with the insurance company, I couldn't start to say whether it was fraud.  If it's not fraud, it's certainly not illegal.  It's possible that your partner regards health insurance for his ex as a means of assuring better stability for his kids.  They spend half their time in her home, and even if they didn't, she'd still be their mom.  Plus, there's a ton of emotional baggage that comes with having a partner who suffers from serious mental illness.  This hundred bucks a month may carry a lot of emotional weight. 


In your shoes, I'd focus on the need for you to have insurance, and look at all the options for acquiring and paying for it.  Don't poke at insurance for the ex - assume it's a benefit for the kids.  Just do what you need to so that you also have coverage.

post #4 of 15

My initial reaction is that I'm very surprised that she's able to stay on his insurance plan at all since the divorce became final. Perhaps your state allows the effective date for the divorce, for health insurance purposes, to be 6 months from the date the decree is filed (i.e. November). Does the divorce decree order him to pay her insurance premium? If so, it's not like he has a choice in paying it.


Not that I blame you for feeling frustrated that he's providing something for her but not you, because I'm sure it's a crappy feeling. Unfortunately sometimes you have to look at the long term and the lesser of two evils, and if this keeps the peace with her--and avoids a fight with the children in the middle--it could be money well spent, so to speak. 

post #5 of 15

And sometimes it's part of the divorce decree not always but sometimes.  But I would think that if they were divorced already and they didn't make a plan to keep her on the insurance then legally he can't do so.  It's kind of on him.

post #6 of 15

So, what happens when the two of you get married? and you want to go on his insurance? Will he NOT add you bc his ex is already there? And just tossing ideas out........if you both know that 'you are each other's one' and you've talked of marriage, why isn't it official yet.......is there 'something' holding you back?

post #7 of 15

If his insurance company only provides coverage for spouses, then yes, what he is doing may be fraud. Some companies do give six month coverages for former spouses, but that isn't the real issue here (of course, if his plan will cover her for six months post divorce, he should do that). She can and should get her own plan; really, since it's a potential fraud issue, on her end she is risking having to pay back any services she receives since she isn't covered. 


As someone already pointed out, what happens when you get married?


He needs to fix that asap.

post #8 of 15

i would approach it delicately. just bring it up in a way that you are not blaming or attacking. he may be able to have her on for 6-12 months post divorce. as someone else mentioned maybe it is something he is doing to help her out as she is the mother of his kids and in a way he is doing it to help them (making sure their mother gets the help she needs to keep her stable). she probably should get on some other sort of insurance though, if your planning at some point to get married, so you can be on insurance too.

post #9 of 15
At first, I was totally On your side thinking, "why hasn't he taken her off his insurance yet?" However, The more I think about it, the more I realize that there are a lot of very legitimate reasons why it might be happening.

In addition to the ones mentioned above, until Obamacare kicks in next year, she may be prevented from getting a plan on her own because of a pre-existing condition.

Also, this might've been a "to stay on good terms" agreement made with her outside of official divorce decrees.

However, I would be most worried about the legality issue. Could he be liable because the plan is under his name?
post #10 of 15
Insurance I have had is for my spouse and I. If he has just not notified them of the status change he could be liable for all money they cover for her (if she technically should not be covered).

It could open him up for a big claim that she would likely not be able to pay him for.

That would concern me.

If he has permission to have her on the plan that is a totally different situation to deal with.
post #11 of 15
Thread Starter 

To update, I discussed my issues/concerns about this with him and he agreed that she's had plenty of time to find her own insurance and that she is going to not be covered under his after the health exchange begins.. It did not result in a big fight at all. I have concerns that she'll actually follow through with getting her own because she doesn't seem to like to take initiative with a lot of things. However, I don't feel that that is his concern anymore and if and when that situation arises, I'll have to deal with that then. I do agree that while there may be legitimate reasons for keeping her covered (especially her mental health,) he is not doing this legally and we can and may be held liable for this. And that especially concerns me. It is not a part of the divorce decree, of that I am sure. And his insurance does not cover partners- only a married partner. 


To answer the what are we waiting for on marriage question... I think we're both enjoying our situation as it is.. However, I expect him to propose in a relatively short time. I think a lot of it is lack of money for ring/wedding.. And, yes.. I want both of those as I've never been married before.


Thanks for all the help. :) 

post #12 of 15

In the event the insurance company learns that they have provided coverage of services to a non-eligible member, they will hold the primary member accountable for those costs. That is to say if they paid for $5,000 of services since Divorce date, they will send your DP a bill for $5,000. I'd count on that. Possibly his employer would also expect reimbursement of their contribution to the premium they paid on her behalf. Unless you want a big bill to come in the mail, you might want to avoid poking the hornet's nest. Are they (insurance, employer) going to come after him and charge him with insurance fraud? I doubt it. He just hasn't filed paperwork to make the adjustment. There's potentially a lot of liability here, but I don't think there's anything he can do about it but wait it out.


The problem is there is generally a limited window (often 30 days) from a significant event (birth, death, marriage, divorce) to file the necessary paperwork to change benefit plans. The only other time changes are allowed is open enrollment (dates vary by employer/plan). At this point I suspect his only option is to wait until open enrollment to drop her. At that point he shouldn't need to provide any (real) reason of why he's removing her (i.e. shouldn't need to provide a divorce decree). If open enrollment will be in November, for example, he can wait it out for 1-1/2 more months and then drop her. Give her warning so she knows the deadline for getting her own insurance (as a courtesy) and then it's done. This means even if she gets insurance today, he still has this dilemma of not being able to remove her until open enrollment--so he will have to continue paying the premium until then. Hopefully his employer's open enrollment isn't during August!


If he has other benefits (life insurance, retirement) where she is listed as the beneficiary, he might also want to make changes there. Listing her as the beneficiary right now is just as well so she will receive those benefits to share with the children (who can't be recipients without a trust while they're minors) in the event of his passing. If you two get married, you'll have a qualifying event (marriage) to qualify him to make changes to those benefits, if desired.


All of this, of course, assumes that you're not in a state that allows the effective date for divorce to be some time (e.g., 6 months) after a divorce is final. If you live in a state that sets this grace period, then there's no foul, and he just has to take care of it in a timely manner (i.e. by the time the grace period ends).

post #13 of 15

A note about open enrollment:  You can only join the plan within 30 days of a qualifying event, or during open enrollment.  In my experience, you can drop insurance coverage for any reason at any time.  You aren't limited to doing that in the open enrollment period. 

post #14 of 15

I wouldn't call that the rule. Plan administrators like to know how much money (from premiums) will be going into the group plan so they can budget benefits accordingly. They don't want thousands of dollars suddenly disappearing from the pool because people cancel. While some might allow it, it's definitely not universal. I've personally never encountered an employer who allows mid-season drops of some--but not all--of a family (as in drop the wife but keep the children on the plan) without a qualifying life event.

post #15 of 15

I've been the HR admin for employers that allow that.  This may be a thing that varies from state to state, and it's honestly not a thing that comes up that often, but people do sometimes drop insurance without qualifying events (usually because they've shopped around and found a better deal, or family income has dropped and the kids qualify for a state plan).  Of course insurers don't want thousands of dollars disappearing from the pool because people cancel, but it's their business to cope with that.  They don't get to keep consumers locked in just because they like it that way.


It's important to note that if the employee refuses coverage, they can't get their dependents covered, but not themselves.

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