Foster v. Group Health Incorporated7/15/2005
Suffolk.
March 10, 2005
Present: Marshall, C.J., Greaney, Ireland, Spina, Cowin, Sosman, & Cordy, JJ.
Practice, Civil, Summary judgment. Insurance, Group, Health and accident. Statute, Construction. Divorce and Separation, Health insurance.
Civil action commenced in the Superior Court Department on September 3, 2003.
The case was heard by Geraldine S. Hines, J., on motions for summary judgment.
The Supreme Judicial Court granted an application for direct appellate review.
We determine in this case the scope of G. L. c. 175, § 110I (a), which mandates that, in certain circumstances the insurer of a group health insurance policy continue to provide coverage to the divorced spouse of a group member. Prior to his divorce, the plaintiff, James J. Foster, now a resident of Massachusetts, was married to Paula Foster, an employee of the New York City Board of Education (New York City) and at all relevant times a resident of New York City. Paula was a member of group health insurance plans offered by New York City, and James received health benefits under those policies as her dependent spouse. Each group insurance plan contained a provision that insurance coverage of a dependent spouse would terminate in the event of divorce from the group member. At some time following the divorce (the record does not say when), the defendants refused to provide continued health insurance coverage to James.
In 2003, James commenced this action in the Superior Court alleging that the provisions of G. L. c. 175, § 110I (a), as amended through St. 1986, c. 579, § 5, require that the defendants continue to provide comprehensive health insurance coverage to him. He relies on the last sentence of § 110I (a), which, since 1986, has provided that continued health insurance coverage "shall apply to any policy issued or renewed within or without the commonwealth and which covers residents of the commonwealth." G. L. c. 175, § 110I (a). For the reasons we discuss below, G. L. c. 175, § 110I (a), is applicable to a divorced dependent spouse if, and only if, the member spouse (here Paula) is a resident of Massachusetts. Because Paula resided in New York at the time of divorce, insured by insurers not subject to Massachusetts regulation, we affirm the summary judgment entered in favor of the defendants.
Facts and Procedural History
In 1972, James married Paula, a teacher in the New York City public school system. New York City contracted with Group Health Incorporated (GHI) and Empire Blue Cross Blue Shield (Empire), both New York insurance companies, to provide comprehensive medical and hospital benefits, respectively, to New York City employees and their dependents enrolled in the New York City Employee Benefits Program. The insurance policies were approved by the New York State Insurance Department, issued in New York, and by their terms were governed by the laws of the State of New York. As a New York City employee, Paula was a covered member of both the GHI and Empire group health insurance plans, and James was entitled, as her dependent spouse, to receive health benefits under those policies for a "nominal" premium. Both policies expressly provided that coverage of a dependent spouse would cease on divorce from the member spouse.
In August, 1987, James became a resident of Massachusetts. He remained married to Paula, who continued to reside in New York City, employed in the public schools. James and Paula were divorced in Massachusetts in 1992. In 2001, on her retirement from her employment by New York City, Paula changed her coverage under the GHI policy from family to individual coverage. I
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