by Guest » Wed Aug 04, 2010 08:59 pm
Hi, first time poster, I moved to the US a little while ago so the insurance business in this country is still a bit daunting to me.
My wife and I both work, we both have our individual insurance. I have a union position so mine is through the union. We have a 6 month old daughter. My wife's birthday is before mine, which means the union will not allow me to have my daughter on my insurance as primary, she has to be on my wife's. We do not want that; my wife's insurance is much more expensive than mine. We dropped my daughter from my wife's insurance, but the union denies primary coverage and makes us put my daughter back again.
My question is if there is anyway to get around this, or is it just plain my terrible luck to be born later in the year? I find it such strange rule and completely random. Why can't I choose where I insure my own daughter?
Thanks for any help and suggestions.
JB
My wife and I both work, we both have our individual insurance. I have a union position so mine is through the union. We have a 6 month old daughter. My wife's birthday is before mine, which means the union will not allow me to have my daughter on my insurance as primary, she has to be on my wife's. We do not want that; my wife's insurance is much more expensive than mine. We dropped my daughter from my wife's insurance, but the union denies primary coverage and makes us put my daughter back again.
My question is if there is anyway to get around this, or is it just plain my terrible luck to be born later in the year? I find it such strange rule and completely random. Why can't I choose where I insure my own daughter?
Thanks for any help and suggestions.
JB
Posted: Mon Dec 06, 2010 05:53 pm Post Subject:
Can I ask if the same rule applies in NY? My wife's health insurance is much more affordable than mine and we are being told that our baby who will be born in Jan. MUST go onto my plan because of the birthday rule. This has caused stress... my single plan costs $85 a week. if I am forced to bump it up to a family plan, that cost goes to $300 per week... simply unaffordable...
Posted: Tue Dec 07, 2010 06:02 pm Post Subject:
In separate communications with the OP, it became apparent that his employer's sponsored plan was a SELF-FUNDED plan. Under ERISA, the plan has certain flexibility to write its own rules outside the jurisdiction of state law. The same would be true in New York State.
You need to know/find out if your employer's plan AND your spouse's employer's plan is SELF-FUNDED or FULLY INSURED. When you have that information, send me an email/pm and we can discuss it further.
Posted: Tue Dec 07, 2010 06:44 pm Post Subject:
My wife's plan is through a union and my plan is a group plan... I am not sure if this answered your question simply because I'm not sure what you are asking...
What does self funded/fully insured mean?
Posted: Wed Dec 08, 2010 05:31 am Post Subject:
Ok i found out her plan is a non-profit. I dont know if that makes a difference
Posted: Wed Dec 08, 2010 12:04 pm Post Subject:
You need to determine if the plan is SELF-FUNDED (the liability for claims rests with the employer) or FULLY-INSURED (the liability for claims rests with the insurance company). Once you have that answer, then we can give better guidance.
Normally, the birthday rule is not used to force coverage, but to identify which plan is primary when a child is covered by more than one plan. Self-funded plans can write more explicit rules, although if found to be discriminatory, they will not be upheld by the US Dept of Labor.
Posted: Sun May 15, 2011 02:13 pm Post Subject: DAxAlAZpWEBK
Birthday rule exceptions.. Bully :)
Posted: Fri Jun 03, 2011 09:29 am Post Subject: OCcYUafEWeKjJ
Birthday rule exceptions.. Reposted it :)
Posted: Mon Jun 25, 2018 09:43 am Post Subject: Birthday Rule
What if gender is same in birthday rule, then whose health plan covers the children?
Posted: Tue Jun 26, 2018 06:14 am Post Subject:
Hello everyone, I'm new here. It is good to be a part of such helpful community.
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