Harrisburg couple Carl Bechdel and Dan Miller were wed in Washington, D.C., during the summer of 2012, a marriage recognized in the district and in the eyes of the federal government -- but not always in the eyes of Pennsylvania's health insurers.
At least, not when it comes to individual and family policies being sold through, and alongside, the new federal health insurance marketplace.
Mr. Bechdel, 60, and Mr. Miller, 57, needed insurance because the coverage they both had through Mr. Miller's employer, the city of Harrisburg, was set to expire upon his retirement. The former member of Harrisburg's city council and one-time mayoral candidate served as the city's elected controller until the end of 2013.
The Harrisburg health plan, whose benefits and restrictions were set by the city, was administered by Highmark Inc., and the Pittsburgh insurer implicitly recognized Mr. Bechdel as Mr. Miller's spouse.
But when the couple turned to Highmark for family coverage purchased out of their own pockets, they were told they would not be recognized as a married couple.
"It never occurred to us there would be a problem," Mr. Bechdel said, mainly because the employer-sponsored plan through Highmark Blue Shield never raised the issue.
After exploring plans through HealthCare.gov and learning that they made too much money as a couple to receive any subsidies toward premium costs, the couple decided to apply for coverage directly through Highmark. On Dec. 8, they sent in a health insurance application, including a check for the first month's premium, and waited for their benefits materials in the mail.
By Dec. 27, the materials still hadn't come.
That's when Mr. Bechdel called Highmark and learned that the "family" plan could not be issued. He was told Highmark didn't issue family or spousal dependent coverage to same-sex spouses because Pennsylvania doesn't recognize such marriages as valid.
"But that's the state government. You're not the state government. Why don't you recognize it?" Mr. Bechdel says he asked of the customer service agent.
A Highmark spokeswoman said changes at the federal level have been a factor in the insurer's policies.
"Our plans were filed for the federal insurance marketplace in June 2013, well before last fall's Supreme Court decision to strike down a key section of the federal Defense of Marriage Act. At the time we filed our plans, we followed state laws on recognizing same-sex marriages," Highmark's Kristin Ash said.
"Now that much has changed in the federal legal definition of same-sex marriage, we are evaluating this for future health insurance plans."
Highmark also operates in West Virginia and Delaware, following its acquisition of Blue Cross Blue Shield plans in those states. In West Virginia -- like Pennsylvania -- same-sex family or spousal plans aren't issued. But in Delaware, where same-sex marriages have been legal since last summer, Highmark does offer such policies.
"We recognize this may be confusing for same-sex spouses," Ms. Ash said.
The prohibition appears to be Highmark's own.
Aetna, for example, does "not distinguish between same-sex and opposite-sex couples" in Pennsylvania or elsewhere, according to company spokesman Walt Cherniak. Aetna also sells individual polices in Pennsylvania through the federal health insurance marketplace.
And UPMC Health Plan also offers family coverage to same-sex couples in its federal marketplace health plans, though UPMC "has recognized [applicants] as domestic partners" rather than spouses, according to a spokeswoman.
Highmark's prohibition isn't mandated by the Blue Cross and Blue Shield Association. On Jan. 27, Blue Cross and Blue Shield of North Carolina announced that it would be selling family coverage immediately to same-sex married couples and domestic partners in its health care exchange plans.
Originally, the North Carolina carrier had intended to start selling such policies effective in 2015, but it sped up the timetable after getting push-back from advocacy groups. A brief campaign had began in mid-January when it was reported that about 20 same-sex couples, who had married in other states, had been sold family plans and later had those plans canceled.
Mr. Bechdel admits that in most ways, at least for him and Mr. Miller, the argument is academic: The cost of one spousal plan would be no different than the cost of the two individual plans they now have (about $650 in combined monthly premiums for their Community Blue plans) and the benefits wouldn't be any different, either.
It's even possible to save money by buying separate individual plans -- together, a couple might make too much to receive a family subsidy, but individually, one partner or the other might be eligible for a subsidy.
But in light of ongoing federal policy changes -- the U.S. Department of Health and Human Services' 2013 announcement that married same-sex seniors on Medicare would be eligible for equal benefits and last summer's announcement that federal employees in same-sex marriages can apply for joint health benefits -- the outcome of this argument likewise seems academic.
Bill Toland: firstname.lastname@example.org or 412-263-2625.