benefits for live-ins......required?

junebug · November 2003

While our state (Texas) and our insurance company (UHC) allow health insurance coverage for the live-in companions of employees, the owner of our small company would prefer not to pay for them. We do contribute towards the cost of coverage for spouses and children. Can we legally NOT pay anything for live-ins?

Don D · December 2003

You say your state 'allows' it. Does that mean your company 'chooses' to go with that? What are you defining as a companion? A companion is typically someone who cares for or accompanies an infirm person. Are you speaking of domestic partners and same sex unions? In the latter event, you should consult an attorney familiar with insurance regulations.

junebug · December 2003

Thanks for your reply. In our case the employee has a girlfriend who has lived with him and his children for several months. The owner does not wish to pay for other than actual married spouses.

Don D · December 2003

If the State does not require it, then it is elective with the employer/plan. Texas is still several states separated from California, Vermont and Massachusetts; so, your boss has a few years to think this one over.

mwild31 · December 2003

Simple answer: No, your company doesn't. Although you could call an attorney if you would like, I would avoid the call and tell the employee no. Maybe once tax laws change & live-ins are on the same par as spouses/children/dependents, you could re-evaluate the situation at that time.

irenesmsaclaims · December 2003

If this is a fully insured plan, you would want to look at the application, which is part of the contract. There should be a section where the employer states how it is going to contribute for employees and dependents. Then look at the definition of dependent in the contract. An amendment to the contract may be needed. The insuror is bound by the state laws, unless you're exempt. In any event, I should think that the insuror should be involved with such a decision not to pay for domestic partners.

mwild31 · December 2003

Hi irenesmsaclaims - the poster already stated that it is allowed in their contract - they as the employer are just not inclined to offer it to live-ins. Could you explain your point further - past the contract part?

irenesmsaclaims · December 2003

Ok, let's say the application says that the employer is to pay a certain percentage for dependent coverage. Then the eligibility part of the contract says that dependents include domestic partners who may not be legally married. If the employer then decides not to pay for the live-in partner, there is a conflict, which could be used if the employee wishes to contest the lack of contribution by the employer, when the employer pays for other dependents. Worst case the employer may have to pay back premiums for such dependents. If the employer goes against the terms of the contract, then that is why I say an amendment may be necessary, so that everything is aboveboard and known to all parties. You are correct that it is up to the insuror's discretion, if they allow dependents as defined, to be common-law spouses, or domestic partners.

mwild31 · December 2003

Thanks for responding x:-)

benefits for live-ins......required?

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