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Insurance questions for divorced families

Amazedstepmom's picture

Ok, my ex is giving me a hard time about insurance coverage and I want to get other opinions. After him brining it to my attention, I do kindof agree but never thought about it in this way.

Me and DH cover insurance- no cost to the ex- no child support exchanged. Insurance coverage has gone to crap over the years but we pay less than $100 per month to insure 5 people.
DH and his kids (2) and my kids (2) are on the policy with a $4000 deductible, going up to $5000 next year. Insurance is essentially useless until deductible met.

If my kids use the coverage first then my kids bills are 100% out of pocket so my ex wants to only be responsible for $800 this year and $1000 next year. It does make sense but....

what if my DH had surgery and ate up the deductible at the start of the plan year, then my kids used it and according to the explanation of benefits there is no bill because insurance pay it... my concern is that he may want his cake and to eat it too and in this instance not pay anything towards medical costs since there essentially there is no bill but this is only because of my DH paying it.

I hope that makes sense. I have no idea what domestics or an attorney would say about it. I am considering consulting one however we have kept it civil and out of courts for the last 9 years so I would prefer to keep it that way. I certainly don't want to screw him but don't want to get screwed myself either...

Comments

fakemommy's picture

If your DH uses the deductible, or his kids do, then your ex should not have to pay anything toward your kids medical bills. Your DH would have used his deductible whether or not your kids were covered, so I agree with your ex there. I don't agree on him only paying 800-1000 dollars. Same concept, if your kids need enough medical care to cover the deductible, that has nothing to do with DH or his kids being on the plan. They would need it either way, so if the deductible is not met, he should pay half of the costs.

canigetabm's picture

I work in insurance and his request makes no sense to me. Let me provide you with an example. Your kid has a surgery the cost is $7,000. The deductible is $4,000 you would agree he is responsible for $800 while you pick up $3,200 and pay the premium.....no way. I don't see how that is "fair". I think I would ask an attorney if something could be drafted that he is responsible for the first $2000 or $2500 next year regardless of who "uses" the deductible first. Since he hasn't contributed to the premium for how many years? My exh pulled this and has never paid a premium in my BS's 15 years. It amazes me. I too just don't want to argue.

misSTEP's picture

I don't know what the right answer is but the scenerio your ex is talking about could just as easily go the other way as well. Plus, what if ONLY your bios with your ex need stuff? What if they use up the entire deductible and nobody else in the family has to go in? Then he is really getting a deal.

I'd say he is still responsible for half of whatever the actual cost is for the bios. Especially since he isn't paying a thing towards the actual cost of the policy.