Get a Decree of Divorce or wait until open enrollment to drop that common-law spouse

Physical and well-woman exams are not the same

I've been feeling stressed and depressed

Q. I recently tried to add my new husband to my benefits plans. I was told that I could not because my common-law spouse is still listed, and that I need to present a Decree of Divorce before I can stop his coverage. What is a common-law spouse? Why do I need a Decree of Divorce? Can I terminate the common-law marriage without a Decree of Divorce?

A. According to Texas law, you entered into a common-law marriage when your spouse and you agreed to marry, lived together as husband and wife, and represented to others that you were married. You represented that you were married to the city of Houston when you listed your mate as spouse on your benefits-election forms.

Once the common-law status exists, the union is treated with the same dignity as a ceremonial marriage and may only be terminated by death, divorce or annulment.

Under the Texas Family Code, if you did not take steps to prove the existence of an informal marriage within two years after you separated and ceased to live together, the law assumes that you did not enter into an agreement to be married.

However, accepting benefits based on a marital status is evidence that will rebut a presumption of no marriage. During open enrollment, you can drop dependents without documentation.

Q. When I scheduled my annual well-woman exam, I said, “physical exam.” I expected a well-woman exam and physical exam to mean the same thing, and that I would not be charged the HMO $20 office visit copay. Why was I charged the $20 office visit copay?

A. You were charged the $20 copay because you made an appointment for a physical exam. When making an appointment, you must request a well-woman exam. There is no copay for a well-woman exam.

Q. I have been feeling very stressed and depressed, and I’m concerned that I will become worse during the holidays. How can I get help?

A. The Employee Assistance Program can help you and your family handle personal problems, work/life stress, depression and addictive behavior. EAP will also assess your condition and may refer you to Magellan Behavioral Health for further help. Using the EAP is always voluntary and strictly confidential. Call the EAP office, (713) 866-4242, for more information or to schedule an appointment.

Magellan Behavioral Health is the mental health provider for people covered under the HMO. Inroads Behavioral Health is the mental health provider for people covered under the PPO. Magellan and Inroads coordinate outpatient and inpatient services for mental health conditions and chemical dependency. You do not need a referral to use either provider. However, these steps will help Magellan and Inroads provide timely care for you and your dependents.

1. You may contact EAP to begin this process.
2. If you don’t call EAP, select a mental health provider listed in the Blue Cross Blue Shield Provider Directory under the Behavioral Health Providers section. If you have selected one not listed, call Magellan or Inroads to verify the provider is a member of the network.
3. Set up an appointment with Magellan, (800) 729-2422, or Inroads, (800) 528-7264. You do not need a referral from your primary care physician.
4. Before your first appointment, call Magellan to get authorization to use the provider. If this is not done, you may be responsible for the cost of the office session. You do not need authorization to use an Inroads provider.
5. Each time you change mental health providers, you must get an authorization from Magellan before your first visit.
6. Patients older than 18 must make the appointment with the mental health provider and get an authorization. The parent or guardian of patients under age 18 may make the appointment and get authorization.

What does it cost?

EAP services are free. If the EAP refers you to a mental health professional:

• HMO — $25 copay per session for 20 outpatient visits per year.
• PPO in-network — $30 copay + 20 percent per session for 30 outpatient visits per year.
• PPO out-of-network — 40 percent after the annual deductible for 30 outpatient visits per year

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Pulse readers can get answers to their medical, dental and insurance benefits questions from the Human Resources Benefits Division's customer service representatives. Marina Mendoza answers your questions in this issue.

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