download - Contra Costa County Bar Association

Domestic Partner Coverage Rights Under
the California Insurance Equality Act
by Ralph L. Jacobson
GJEL Accident Attorneys
Under California law, registered
domestic partners
are “two adults who
have chosen to share one
another’s lives in an intimate and
committed relationship.” 1 The California
Domestic Partner Rights and
Responsibilities Act of 2003 required
that registered domestic partners be
provided the same rights, protections
and benefits as spouses; and
that they also be subject to the same
responsibilities, obligations and duties
under law. 2
One year later, the California Insurance
Equality Act 3 (hereafter referred
to as The Equality Act) was
enacted to mandate that insurance
policies governed by the law provided
coverage for the domestic
partner equal to that provided for
the spouse of an insured. It states:
(a) Every policy issued, amended,
delivered, or renewed in this state
shall provide coverage for the
registered domestic partner of an
insured or policyholder that is
equal to, and subject to the same
terms and conditions as, the coverage
provided to a spouse of an
insured or policyholder. A policy
may not offer or provide coverage
for a registered domestic partner if
it is not equal to the coverage provided
for the spouse of an insured
or policyholder. This subdivision
applies to all forms of insurance
regulated by this code.
(b) A policy subject to this section
that is issued…shall be deemed
to provide coverage for registered
domestic partners that is equal to
the coverage provided to a spouse
of an insured or policyholder.
(c) It is the intent of the Legislature
that, for purposes of this section,
“terms,” “conditions” and
“coverage” do not include instances
of differential treatment
of domestic partners and spouses
under federal law.
The Equality Act also amended
Insurance Code Section 10121.7, regarding
group health insurance, to
read:
“A policy of group health insurance
that provides hospital, medical,
or surgical expense benefits
shall provide equal coverage to employers
or guaranteed associations,
as defined in Section 10700, for the
registered domestic partner of an
employee, insured, or policyholder
to the same extent, and subject to
the same terms and conditions, as
provided to a spouse of the employee,
insured, or policyholder, and
shall inform employers and guaranteed
associations of this coverage. A
policy may not offer or provide coverage
for a registered domestic partner
that is not equal to the coverage
provided to the spouse of an employee,
insured, or policyholder.”
Prior law had required group
health care insurance plans and
policies of group disability insurance
to offer coverage for the domestic
partner of an employee or
insured to the same extent as coverage
provided to a dependent. 4 That
statute was amended by the Equality
Act as well. This prior definition
seemed to be at odds with the statutory
definition of dependent, which
was:
“’Dependent’ means the spouse
or child of an eligible employee,
subject to applicable terms of the
health benefit plan covering the
employee...” 5
On its face, this definition did not
seem to include the domestic partner,
leaving ambiguity.
Prior to adoption of the Equality
Act, there were also gray areas
as to the contractual standard of
what constituted a dependent in a
health insurance contract. Most revealing
in that regard is Prudential
Ins. Co. of America, Inc. v. Superior
Court, 6 which concerned whether
or not a college student daughter of
an insured was, or was not, a qualified
dependent under her parents’
health insurance policy at the time
she suffered catastrophic injuries.
Under the policy, qualified dependent
status was defined to include
children of the insured over the age
of 18 who were full-time students.
In this case, the insured’s daughter
had chosen not to enroll in school
for the quarter following her freshman
year due to personal problems,
but she had retained the right to
seek re-admission. Evidence from
the school indicated that this was
not an unusual circumstance; and
the parents and student asserted
she should be deemed a qualified
26
MARCH 2013