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Appeals court upholds MCHCP's denial of benefits

Appeals court upholds MCHCP's denial of benefits

March 21st, 2018 by Bob Watson in Local News

Survivors of Missouri Consolidated Health Care Plan's retired beneficiaries cannot be covered by the plan after the beneficiary dies — unless they joined the plan at the time the beneficiary first retired.

That was the ruling Tuesday from a three-judge appeals court panel in Kansas City, upholding last year's ruling by Cole County Circuit Judge Jon Beetem.

Janice Spurgeon, of Owensville, sued the state health care agency in 2014 after its Board of Trustees denied her request to be added to the plan after her husband died in March 2014.

Her husband, Gary Spurgeon, had worked for Missouri's Division of Alcohol and Tobacco Control for nearly 34 years — until he retired Dec. 1, 2009.

Court records indicate he elected to continue his MCHCP health care benefits in his retirement — but he did not choose to have Janice added to that policy when he retired.

At the time — and continuing through the two sets of court trials and appeals hearings — she was covered by a health care policy through her employer, Crawford Electric Cooperative.

Janice Spurgeon's attorney — Joe Page, of Jefferson City — said Tuesday he doesn't expect she will appeal the case to the Missouri Supreme Court.

Neither Page nor attorney Chuck Hatfield, who represented the MCHCP in the nearly four-year legal battle, commented on Tuesday's appeals court ruling.

Page has argued from the beginning of the case that state law allowed Spurgeon to wait to sign up for her husband's benefits until after his death.

That law states benefits end when an employee stops being active, unless the benefits are continued by the beneficiary — or the spouse "of deceased persons receiving an annuity or retirement benefit."

Spurgeon said she qualified under those provisions — and because an MCHCP representative had told her in October 2013 that she could submit a survivor's enrollment application after her husband died.

Although that call is noted in the appeals court's two rulings in the case, it wasn't the focus of Page's appeals and wasn't a part of the court's analyses in either opinion.

Beetem ruled in 2015 that Spurgeon's lawsuit failed "to state a claim upon which relief could be granted," but the Kansas City appeals court in February 2016 sent the case back to Cole County.

In that eight-page ruling, the court said Spurgeon "was entitled to a decision on the merits," rather than having her case dismissed as it had been.

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That first appeals court ruling also noted MCHCP had argued "its decision to deny Spurgeon's application to enroll in the plan was lawful under its interpretation" of the law, and of a board regulation "that a retiree's survivors may elect to continue MCHCP coverage only if the survivors had MCHCP coverage at the time of the retiree's death."

However, the 2016 appeals court ruling specifically noted it wasn't "offering any opinion on the merits of (those) arguments."

After holding a new hearing in October 2016 and considering both sides' written arguments, Beetem last May ruled MCHCP had "acted in accordance with the law in denying (Spurgeon's) enrollment."

In his May 2017 ruling, Beetem said the MCHCP's regulations — part of Missouri's Code of State Regulations — clearly states: "At the time of a retiree or terminated vested subscriber's death, his/her survivor(s) may elect to continue coverage if the survivor(s) had MCHCP coverage at the time of the subscriber's death."

Beetem wrote last year, "She was covered under her employer's health insurance plan. Accordingly, there was no MCHCP coverage for her to continue. For this reason, MCHCP denied Mrs. Spurgeon's application. MCHCP's decision is not only reasonable, but is required by law."

In its 10-page ruling Tuesday, the appeals court said: "Gary (Spurgeon) had the opportunity to elect MCHCP coverage for (Janice) Spurgeon at the time of his retirement, based on Spurgeon's prior six months of coverage through her own employer.

"Gary was required to make an election at that time pursuant to (the state law). He chose not enroll Spurgeon at that time and, consequently, Spurgeon had no MCHCP coverage she could elect to continue at the time of Gary's death."