Eligibility Issues


Frequently Asked Questions Eligibility Issues Q. My spouse and I are separated. Is my spouse still covered under my medical plan? A. Yes. Unless you divorce, your spouse is still covered. Q. Can I have my spouse removed from coverage under my medical plan while we are still married to one another? A. No. A spouse can only be removed from coverage by divorce or death. Q. I am divorced. Is my former spouse entitled to coverage under my medical plan? A. No. After your divorce, your former spouse can no longer be covered under your medical plan. You, as the plan member, must provide LEHB with a copy of your divorce decree within thirty-one days of your divorce. If benefits are paid for services to an ineligible former spouse as a result of the member's failure to make notification to LEHB of the member's divorce, the member will be responsible for the payment of those invoices and claims. Q. I am divorced and I notified LEHB and my former spouse continues to use my medical benefits. What should I do so that I am not held responsible for these medical bills? A. Once you provide LEHB with a copy of your divorce decree, if the former spouse continues to use benefits they are not entitled to, they will be held responsible to the provider. Q. The court ordered I provide health benefits to my former spouse. Would LEHB cover my ex-spouse then? A. No. Regardless of a court order, LEHB is not required to cover former spouses within the group at no charge. Your spouse would be eligible for COBRA coverage, at prevailing charges. Of course, because of the court order, you will be responsible for payment of premiums. Q. The new Federal Heath Care bill says children up to 26 can be covered by my plan. Can I put my child(ren) on now? A. Not yet. At this time the mechanism for covering dependant children has not been established. We do not know if there are restrictions such as college students, health issues or if the member can be charged for this privilege. As soon as all the questions are answered and guidelines established, LEHB will do all that is required to provide benefits to you and your eligible dependants. Q. I am marrying someone with children. Can my step-children be covered on my plan? A. No. Step-children are not eligible dependants. LEHB can only cover natural born children of the member and those children who are adopted by the member.

Frequently Asked Questions

Eligibility Issues

Q. My spouse and I are separated. Is my spouse still covered under my medical plan?
A. Yes. Unless you divorce, your spouse is still covered.

Q. Can I have my spouse removed from coverage under my medical plan while we are still married to one another?
A. No. A spouse can only be removed from coverage by divorce or death.

Q. I am divorced. Is my former spouse entitled to coverage under my medical plan?
A. No. After your divorce, your former spouse can no longer be covered under your medical plan. You, as the plan member, must provide LEHB with a copy of your divorce decree within thirty-one days of your divorce. If benefits are paid for services to an ineligible former spouse as a result of the member's failure to make notification to LEHB of the member's divorce, the member will be responsible for the payment of those invoices and claims.

Q. I am divorced and I notified LEHB and my former spouse continues to use my medical benefits. What should I do so that I am not held responsible for these medical bills?
A. Once you provide LEHB with a copy of your divorce decree, if the former spouse continues to use benefits they are not entitled to, they will be held responsible to the provider.

Q. The court ordered I provide health benefits to my former spouse. Would LEHB cover my ex-spouse then?
A. No. Regardless of a court order, LEHB is not required to cover former spouses within the group at no charge. Your spouse would be eligible for COBRA coverage, at prevailing charges. Of course, because of the court order, you will be responsible for payment of premiums.

Q. The new Federal Heath Care bill says children up to 26 can be covered by my plan. Can I put my child(ren) on now?
A. Not yet. At this time the mechanism for covering dependant children has not been established. We do not know if there are restrictions such as college students, health issues or if the member can be charged for this privilege. As soon as all the questions are answered and guidelines established, LEHB will do all that is required to provide benefits to you and your eligible dependants.

Q. I am marrying someone with children. Can my step-children be covered on my plan?
A. No. Step-children are not eligible dependants. LEHB can only cover natural born children of the member and those children who are adopted by the member.