We’re Re-Certified!

Brad and I have received word that we have been re-certified as part of the University's health insurance benefit eligibility audit.   Now, why we had to be re-certified to begin with when the University already holds a certified copy of our marriage certificate and both marriage and divorce records are public raises interesting questions.

Still, we hare happy to be re-certified and wondering about the legal effect of this language from the re-certification letter (emphasis added):

Ineligible Family Members Voluntarily De-enrolled from UC-sponsored coverage:
If during this process you requested that your ineligible family member(s) be removed from your UC-sponsored
plan coverage, you do not need to take further action to de-enroll your family member(s)
from medical, dental, vision, and legal plan coverage. However, you must de-enroll ineligible
family member(s) from dependent life insurance and Accidental Death & Dismemberment
(AD&D) coverage, if they are enrolled in these plans. This is an important step because any
future claim filed on behalf of an ineligible family member will not be payable and any premiums you
have paid will not be refunded to you.
After the benefits coverage has ended, your ineligible family member(s) will not be eligible to
continue health plan coverage through COBRA. However, UC’s COBRA administrator offers a
website called health compare.com which might provide a starting point for you if you need to
purchase medical coverage. UC has not evaluated and does not endorse this website; there are
numerous other similar resources from which you can purchase individual coverage. Your medical
plan will send a HIPAA Certificate of Creditable Coverage which you may need to obtain health
coverage for your family member(s) elsewhere.

Really?  If you continue to pay health insurance premiums for an ineligible family member, the University doesn't just spit them right back?  It takes them and you are now on notice that it takes them with no intention of providing health insurance coverage and with no intention of kicking the premiums back?

What is this, some kind of liquidated damages clause?  Or, is it a "don't even think about" warning to employees desperate to obtain affordable health insurance coverage for ineligible family members (that child who just turned 26; the former spouse without coverage of their own; and so on)? Or, is this the policy of Secova, Inc. the health benefits auditor firm selected as UC's contract vendor for this coverage?

Employers don't discuss health insurance eligibility audits in public very much, but the eligibility audit industry talks.  Ironically, the ACA's extension of eligible dependent coverage to age 26 has made the hunt for older, sicker, and more expensive enrolled ineligibles even more heated. It is the older people who feel the pressure to try to remain covered and to not be forced to the exchange or commercial insurance market. Young people, after all, are generally quite inexpensive. So we see it, embrace the young cheats, if you can, and ferret out the older ones.

Every time I consider health insurance benefit eligibility audits I consider the absurdity of claiming all Americans want to be free to be uninsured when so many are, apparently, trying to get inside the affordable health insurance tent that a whole industry has grown up around efforts to try to keep them out.

 

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