MSP corrects error

Authority Health Insurance BC
Details

Erika contacted our Office because she felt it was unfair that the Ministry of Health refused to retroactively remove her ex-spouse from her Medical Services Plan (MSP) account. Erika said her ex-spouse had been covered under her former employer-paid account, and his name was automatically included under her self-pay account when her employer coverage was cancelled in November 2009.

Erika separated from her ex-spouse in December 2009. She explained that she was unaware that she was responsible for paying the premiums for him until July 2010 when she received her first bill from Health Insurance BC (HIBC) for $714 for medical premiums. At the time, Erika said she contacted HIBC to request that her ex-spouse be removed from her account retroactively because of the separation. She was told that he would be removed as of September 2010 but that nothing could be done about the previous months’ billing.

We investigated to determine whether the process followed by HIBC was reasonable. We contacted the ministry and were told that when a person applies to cover his/her spouse, the person assumes responsibility for remitting premiums on behalf of the spouse. MSP explained that when a request is received to remove a spouse, the spouse is removed at the end of the month the request is received and the spouse is then set up on his/her own account. When a couple has been separated for months or years, the client must provide proof of a legal separation or a divorce agreement in order to retroactively cancel a spouse from the premium account. Otherwise, cancellation may only take place at the beginning of the month following the request.

MSP advised that according to their records, in March 2010 Erika’s former employer removed her name from their group account effective November 19, 2009. The employer had submitted an earlier request in November 2009 but the cancellation had not been processed. MSP noted that credits for retroactive cancellations are allowed up to a maximum of two months including the current month. MSP explained that when HIBC processed the employer’s cancellation request on March 30, 2010, there was no record of HIBC having received the November 2009 cancellation request. Therefore, Erika’s name was removed from the employer-paid account as of January 31, 2010. A self-pay account was established under Erika’s name effective February 1, 2010 and since her ex-spouse’s name had been included under her employer-paid account; his name was automatically included under her self-pay account.

According to MSP, Revenue Services of BC changed Erika’s address on their system and premium invoices were sent to the new address starting in July 2010. Their records show that Erika spoke with HIBC in July 2010, requested that her ex-spouse’s name be removed from her account and confirmed her correct address. MSP indicated that the ex-spouse’s name was removed from Erika’s account as of July 31, 2010, which was the earliest date HIBC could make the adjustment because Erika did not provide a legal separation or a divorce agreement.

In response to our investigation, MSP reviewed the cancellation notice from Erika’s previous employer and noted that a new address had been provided. However, HIBC had not updated Erika’s account. Due to the delay in the employer submitting a request to cancel Erika’s account and due to HIBC not updating her address, MSP agreed to approve Erika’s request to remove her ex-spouse’s name from her account as of February 1, 2010. With this adjustment, MSP advised that $270 was removed from Erika’s outstanding balance.

Category Health
Type Case Summary
Fiscal Year 2010
Location The Lower Mainland