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Legalease, Lawyer
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Is a self-insured plan (health) employer excluded from the

Resolved Question:

Is a self-insured plan (health) employer excluded from the Minnesota law which states that an ex-spouse is not required to pay COBRA premiums while the employed ex-spouse pays family premiums for their dependent child?
Submitted: 1 year ago.
Category: Legal
Expert:  Legalease replied 1 year ago.

Hello there ginger -

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I am so sorry, but I find your question to be a bit confusing. Can you explain to me what is happening or has happened in this situation so that I can be certain I am reviewing and researching the right sections of the law?

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MARY

Customer: replied 1 year ago.

I am divorced from a county employee. I was given the option to continue with the health insurance provided by his employer through COBRA. So I took it and have been paying and receiving this health insurance for the past 20 years. It recently was brought to my attention that an ex-spouse who continues the coverage does NOT have to pay premiums IF the ex-spouse employee is paying family premiums at the same time to cover a dependent child. My ex (the county employee) was paying family premiums for a period of 12 years while I ALSO was paying for my single coverage. However, this county employer tells me recently that they are a self-insured plan, and are EXCLUDED from the MINNESOTA law that dates back to 1988. Are they, indeed, excluded, and therefore, do not owe me a refund? Or am I justly due a 12-year premium refund under this law. The insurance company is Blue Cross/Blue Shield.

Expert:  Legalease replied 1 year ago.

Hello there

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Thank you for the additional explanation because it did help to understand where you are coming from on this. While most states have laws prohibiting the health insurance company from charging an additional premium in these circumstances (except in cases where the ex who carried the insurance has remarried and then the insurer does not have to carry both a wife and an ex wife under the plan for the same family plan premium) -- because the county is NOT an insurance company or an insurance provider to the public, they can get away with charging an additional premium under these circumstances. Self insured means that the county is paying all medical claims and bills - the insurance company does not pay them (the only reason why the plan is a BC.BS plan is because the county pays the insurer to process the claims and then when the actual bills for the medical providers must be paid, the county pays those bills -- not the health company administrator). So, because the county is not regulated under the health insurance laws in Minnesota they are exempted from many of the consumer protection provisions that a health insurance company must abide by there.

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Please let me know if you have further questions. I genuinely wish I could have given you better news on this answer, but self insured companies and employers are an entity unto themselves in every state and they get away with more things than a regular insurance company would otherwise get away with doing simply by virtue of the fact that they are paying the bills themselves.

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MARY

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Legalease, Lawyer
Category: Legal
Satisfied Customers: 14623
Experience: 15 years exp all aspects of general law
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