Your Health Plan's Weird Rules

Most of Storck's clients have added a spousal surcharge if the spouse has an option for coverage elsewhere but is on the employee's plan. These surcharges generally range from $25 to $50 per month and are charged whether or not the spouse participates in his or her own employer's health plan.

Can my employer remove my spouse off the company health plan if they become eligible for another group health plan?

Yes, says Lieberman.

"A spouse's eligibility on another health plan is considered a qualified event, which allows the spouse to be removed from the employee's plan," she says. Notification of the event must be provided to the employer within 30 days. The employee will not need to wait until the next open enrollment to make the change.

Does an ex-spouse have to stay on an employee's health plan until the next open enrollment period if the employee doesn't promptly notify the company of a divorce?

No.

"In most cases, an ex-spouse is terminated from the plan and notified of their COBRA continuation rights at the time that the employee notifies their employer of the divorce," Lieberman says.

Can an employer kick someone off the company health plan when they're eligible for Medicare?

No. An employer cannot drop an employee or a spouse from the company's health plan if they become eligible for Medicare.

Leiberman explains the criteria that determine the primary payer for claims:

• If the group is more than 20 employees, then the group coverage is primary and Medicare is secondary.
• If the group is fewer than 100 employees and the spouse is disabled, Medicare will be primary and the group plan is secondary.
• For groups of more than 100 employees, the group plan is primary unless the disabled insured has been receiving dialysis for 39 months, in which case Medicare will be primary.

Here's more from Medicare about primary and secondary payers.

For more answers about group health plans, read Hey, can my employer do that?

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