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Wife's employer won't give her the same benefits that everyone else gets.

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  • Wife's employer won't give her the same benefits that everyone else gets.

    So my wife is a preschool teacher for a very small non-profit center in Massachusetts and has been for years. Up until this past year they used to give their employees an "allowance" to help cover the cost of health care. This amount of money was handled in one of two ways one, it went to insurance costs and that was that or two, for those who did not need insurance through work (like my wife who was insured through me) the money was added to their paychecks as "Rate 2" with "Rate 1" being their salary. My wife was complete happy with this because it worked out to being a little bump in pay which is nice. Now this year everything changed. They came in saying that supposedly they way that they were handling everything was "illegal" (this very well could be I have no idea) and every thing insurance wise with the company was being changed. The plan they came back with was going to be premiums 100% paid for by the employer with a $2000.00 deductible but $1000.00 of it again being paid by the employer. Now we were upset that she was losing the extra pay but hey extra insurance can't hurt especially since she has a couple medical things that can cost some serious cash even after my coverage. Now here is where the fun starts, when she went to submit the forms her boss refused them because she had already had other insurance. My wife explained that you can have more then one, lots of people do but all she got in return were kind of not my problem answers. Now I could be remembering some of these wrong but things like: "its illegal to have more then one", "I've never herd of such a thing", "it would be impossible to file anything", "no", and at one point what I felt is the truth sneaked out, something along the lines of "the board feels that this should just be for those who can't get insurance elsewhere." My wife has since tried going over her boss's head by calling the rep. from the insurance company who is based somewhere in the south from the sound of her accent so I don't know if she was giving us the run around or basing information on laws from a different state but basically told us that we couldn't do it either and that we couldn't submit the paperwork to the company. So the next thing my wife did was try to call a couple of different state departments (not sure which offices) and got nothing but run around and phone tag. When it became clear nothing was going to happen she asked what she (and the other not nearly as vocal about the problem employees) would receive as compensation for the loss of wages, their response, "Nothing, that was a discontinued program and you don't qualify for the new one." So we are stuck and I turn to you, lawyers of the internet. Can they refuse to submit her forms and decide on behalf on the insurance company that she can't be covered? Can the take away money that we have come to count on as income with out compensation? Can they pick which employees get which benefits? Any help would be greatly appreciated so thank you in advance.

  • #2
    Re: Wife's employer won't give her the same benefits that everyone else gets.

    I wish to inform you that your wife can claim insurance from her employer. In this regard insurance policy rules will determine your wife eligibility and if insurance -policy no where restrict your wife from having two policies then employer may not refuse. If your wife has suffered any loss then that loss can be claimed from her employer. Your wife can send a demand notice after which if compensation is not provided then lawsuit can be filed.

    AFF

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    • #3
      Re: Wife's employer won't give her the same benefits that everyone else gets.

      First a disclaimer - here in the forum we are all laymen.

      What you are looking for is called Coordination of Benefits, or COB. 211 CMR 38.00 lays out pretty precisely which plan is to be used in what order.

      They can change your wife's salary as they see fit (absent a contract). As to benefits, they can only deny her if they deny others in her same job category (part time, temporary, union vs non union, etc). If someone doing essentially the same job as her receives benefits so should she.

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      • #4
        Re: Wife's employer won't give her the same benefits that everyone else gets.

        They are free to change her wages with advance notice. They are only required to make sure she earns minimum wage. Employers are permitted to only offer benefits to certain classes of employees and to use reasonable screening criteria to determine those classes. For example they can offer to only people working more than 38 hours per week. They can offer to all white collar employees only. They can offer to all office staff and not factory staff. They can offer to only regular teachers or licensed teachers. You have not provided enough info to clearly determine whether she can be excluded via these means. You have not indicated the number of employees either. If you care to lay out all the positions, hours etc, we can attempt to help more.
        Due to a recent promotion, I should now be referred to as Major Obvious.

        I would not be trying to provide information and knowledge if I did not sympathize.

        Some days it is just not worth chewing through the restraints to face life.

        Comment


        • #5
          Re: Wife's employer won't give her the same benefits that everyone else gets.

          Ask both of your insurance companies for a copy of their policies regarding COB (Coordination of Benefits). These policies dictate how the companies agree to cover expenses for individuals who carry more than one type of health insurance. Let your medical providers know which insurance is primary and which is secondary, since they must file them in this order. Keep a file of your Explanation of Benefit statements, as well as any correspondence with either insurance company or your medical providers. If your insurance situation changes and you lose coverage, notify the other insurance company immediately.

          Comment


          • #6
            Re: Wife's employer won't give her the same benefits that everyone else gets.

            Everyone is getting off track with coordination of benefits. That relates to which policy pays first. The primary insured, is always covered primary on their policy. A childs bill are paid in accordance with a logical method of establishing liability. Usually the birthday rule is used, unless the child is in a familial situation which is the product of divorce and/or remarriage, in which case court order takes precedence. Though states are pushing more and more to have an order specify one parent is to provide coverage, this can backfire on the child, by relieving other insurance companies from having to provide second or third level coverage. If the parents get along, the best order, is that insurance is to be provided by any parent when financially practical. This can potenitally give the child coverage through dad, mom as well as both step parents. Which policy covers first, second, third or fourth then falls back to the birthday rule which is used when both parents have insurance. If mom was born in January, dad in February, step dad in March and step mom in April. The insurances would pay in that order.
            Due to a recent promotion, I should now be referred to as Major Obvious.

            I would not be trying to provide information and knowledge if I did not sympathize.

            Some days it is just not worth chewing through the restraints to face life.

            Comment


            • #7
              Re: Wife's employer won't give her the same benefits that everyone else gets.

              Actually most states have their own methods for COB depending on a variety of factors, including if one is a government plan.

              I addressed that bc it appears to be part of the reason she was denied.

              Comment


              • #8
                Re: Wife's employer won't give her the same benefits that everyone else gets.

                Originally posted by goddessoflubboc View Post
                Actually most states have their own methods for COB depending on a variety of factors, including if one is a government plan.

                I addressed that bc it appears to be part of the reason she was denied.
                As far as government plans being a factor that is not the case here. She works for a small (30-40 employee) private non-profit preschool and I work for a giant retail corporation.

                Comment


                • #9
                  Re: Wife's employer won't give her the same benefits that everyone else gets.

                  Originally posted by Disagreeable View Post
                  They are free to change her wages with advance notice. They are only required to make sure she earns minimum wage. Employers are permitted to only offer benefits to certain classes of employees and to use reasonable screening criteria to determine those classes. For example they can offer to only people working more than 38 hours per week. They can offer to all white collar employees only. They can offer to all office staff and not factory staff. They can offer to only regular teachers or licensed teachers. You have not provided enough info to clearly determine whether she can be excluded via these means. You have not indicated the number of employees either. If you care to lay out all the positions, hours etc, we can attempt to help more.
                  There are less then 50 employees I think its closer to 30. There are part time aides, part time teachers and full time teachers. Teachers are licensed and certified as either just a Teacher or a Lead Teacher (licensing and certifications through the State of Massachusetts) based on classes taken and experience. Now when it comes to my wife she kind of hits everything you would think she needs to hit, she has been there for years, full time and is lead teacher certified.

                  Comment


                  • #10
                    Re: Wife's employer won't give her the same benefits that everyone else gets.

                    Originally posted by jkeeler View Post
                    There are less then 50 employees I think its closer to 30. There are part time aides, part time teachers and full time teachers. Teachers are licensed and certified as either just a Teacher or a Lead Teacher (licensing and certifications through the State of Massachusetts) based on classes taken and experience. Now when it comes to my wife she kind of hits everything you would think she needs to hit, she has been there for years, full time and is lead teacher certified.
                    It sounds like they are just trying to save money by not offering "duplicate" insurance. It may be legal, if they apply it to others across the board. Where I would have an objection to it, if formulating an argument, is not the coverage per se, but the deductible. How does the difference in your insurance deductible stack up to the $2000 with $1000 paid? If you can formulate a "me too" comparable argument, she may be able to get a FSA or wage adj, to factor the difference in plan out of pocket costs.
                    Due to a recent promotion, I should now be referred to as Major Obvious.

                    I would not be trying to provide information and knowledge if I did not sympathize.

                    Some days it is just not worth chewing through the restraints to face life.

                    Comment


                    • #11
                      Re: Wife's employer won't give her the same benefits that everyone else gets.

                      It is not legal to not offer medical insurance just bc she has alternative coverage.

                      What they CAN do is make her an offer of increased salary in lieu of insurance.

                      Comment

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