insurance fraud?
michelle j asked:
Is it insurance fraud to list someone as your husband on your health insurance when you have been together for 9 yrs and have 3 children together? we just never got married and i do pay for it out of my check bi-weekly…
Yes.
But you can just go down to the court house, and get married on your lunch hour, to fix that.
Cat
21 Jun 09 at 4:42 am
Not necessarily. Firstly check to see what your health plan’s definition of “family” and “spouse” is. Having a child and living in the same house with a partner might meet the Plan’s requirements.
Secondly, your State might have particular rules that qualify you and your partner to enroll in a private health plan as a family.
Lastly, does your state recognize Common Law marriages? If so, being together for 9 years and having 3 children together probably will fit the bill. In that case, you probably have been legally married for a while.
If none of the above are true, I wouldnt call it insurance fraud but your partner might not be eligible for coverage. In that case the insurance co might not pay any claims filed on his behalf or will want it’s money back for claims already paid so tread carefully. I wouldnt pick up the phone and ask the insurance co straight out because that will tip them off. Instead, I’d approach your HR dept and ask someone there.
On a side note, it can be messy having a situation like yours if there is some sort of contingency event. Suppose something happened to you or your partner. Can you legally inherit their property? Are you eligible to receive a life insurance (hopefully you have it, since you have 3 kids) payout? Stuff like that. Whatever your personal beliefs regarding marriage are, being married affords you rights and protections (and obligations) that unmarried people do not have. Look into it.
sothere!
22 Jun 09 at 6:10 pm
Yes.
He’s not your husband.
He’s a long term shack up.
When the health insurance company finds out — they will come after you for anything they paid for on his behalf.
How about a trip to the court house and make it legit? People have gotten married for worse reasons!
MSAD
25 Jun 09 at 3:15 pm
Hi,
I think sothere is right. You’re carrying on a live-together.This type of relationship is gaining a kind of legal and social status these days.So,you should check this out from a lawyer.
Kaushik A
26 Jun 09 at 3:15 pm
If you’re not married, then yes, it’s insurance fraud. If they find out about it, they will bill YOU, the SUBSCRIBER, for full reimbursement of everything they’ve paid out on his behalf.
Why don’t you just run down to the courthouse next week and make it legal?
mbrcatz17
27 Jun 09 at 6:34 am
Yes. If your plan stipulates that a “spouse” is defined as a legally married spouse, you are committing fraud by listing your significant other on the policy.
Be forewarned that many companies are doing dependent eligibility audits to catch employees in your situation. If your employer or insurer decides to audit you, they will request a copy of a marriage certificate.
When you are not able to provide the document showing that you were married for the duration of the time that you’ve claimed him on your policy, the penalties can be stiff. For example, the insurer could revoke payment of all medical claims paid on his behalf. The doctors/hospitals who had payments taken back by the insurance company will come after you for the money. Your employer could force you to pay back any premiums they contributed on your “husband”’s behalf. And…even worse…your employer could even fire you for ripping them off.
So, to answer your question, yes you are committing fraud. Geez…if you want all the perks of being married (such as providing insurance through your employer), you’ve been together 9 years, and have 3 kids together, then why not get married already? Or else don’t expect all the perks of being married if you’re not willing to do it.
I’d highly recommend reading the following recent article from Business Week, so that you can understand what could happen if you continue to commit this fraud:
“You’ve Got Dependents? Prove It”
A similar article from the Wall Street Journal:
More recent articles about auditing to make sure dependents/spouses are legit:
sarah314
28 Jun 09 at 6:28 pm