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Brady v. Brady

United States District Court, M.D. Florida, Tampa Division

July 16, 2019

MICHELLE A. BRADY, Plaintiff,
v.
SHAUN J. BRADY, ET AL., Defendants.

          ORDER

          SUSAN C. BUCKLEW JUDGE

         This cause comes before the Court on two motions: (1) the Blue Cross Defendants' Motion to Dismiss (Doc. No.4), which Plaintiff opposes (Doc. No. 5); and (2) Plaintiff's Motion to Remand (Doc. No. 5), which the Blue Cross Defendants oppose (Doc. No. 13). As explained below, Plaintiff's motion is denied, and the Blue Cross Defendants' motion is granted.

         I. Background

         Plaintiff Michelle A. Brady alleges the following in her amended complaint (Doc. No. 1-1): Plaintiff and Defendant Shaun J. Brady (“Mr. Brady”) were married in November of 2009 in Massachusetts. Thereafter, Plaintiff was covered under Mr. Brady's health insurance from Defendant Blue Cross and Blue Shield of Massachusetts, Inc., which was provided through Mr. Brady's employment with the federal government.

         Plaintiff and Mr. Brady divorced in early 2011, and their divorce agreement stated that Mr. Brady was required to continue to provide and maintain health insurance for Plaintiff as long as his employer provided such coverage and neither Mr. Brady nor Plaintiff had remarried. Later in 2011, Plaintiff moved to Florida.[1] After the divorce and for the next seven years, Defendants Blue Cross and Blue Shield of Massachusetts, Inc. and Blue Cross and Blue Shield of Florida, Inc. (collectively, “Blue Cross”) remitted payments to Plaintiff's medical service providers.

         In May of 2018, Mr. Brady remarried, and he attempted to add his new wife to his health insurance plan. At that time, Mr. Brady disclosed to his employer that he had divorced Plaintiff in 2011-a fact that he had previously withheld from his employer and Blue Cross. Because Mr. Brady's employer and Blue Cross believed that Mr. Brady was married to Plaintiff from 2011 through 2018, they had provided health insurance coverage for Plaintiff. However, the health insurance plan specifically prohibited a divorced spouse from remaining on an employee's health insurance plan under the same terms as when they were married.

         As a result, Plaintiff's health insurance coverage was terminated retroactively to the purported date of the Bradys' divorce.[2] Blue Cross then reversed payments previously made to Plaintiff's medical service providers, and Plaintiff began receiving invoices from her medical service providers seeking payment. To date, Plaintiff's medical service providers have sought nearly $900, 000 from her for their prior services.

         In April of 2019, Plaintiff filed suit against Mr. Brady and Blue Cross in state court. She asserted the following claims: (1) fraud against Mr. Brady; (2) breach of contract against Mr. Brady; (3) promissory estoppel against Blue Cross and Blue Shield of Massachusetts, Inc.; and (4) promissory estoppel against Blue Cross and Blue Shield of Florida, Inc. On May 23, 2019, Blue Cross removed this case based on the federal officer removal statute and federal question jurisdiction. Plaintiff now moves to remand this case, arguing that the federal officer removal statute does not provide a basis for removal and that a federal question does not exist. Blue Cross opposes the motion and seeks dismissal of the promissory estoppel claims asserted against them.

         II. FEHBA

         Before addressing the motions, background regarding the Federal Employees Health Benefits Act (“FEHBA”) is necessary. At all relevant times, Mr. Brady was a federal employee, and his insurance plan was provided under the Federal Employees Health Benefits program. Specifically, Mr. Brady was enrolled in a Service Benefit Plan, which is a health insurance plan for federal government employees and their family members that is governed by FEHBA.

         A. The Service Benefit Plan

         Federal employees do not contract directly with Blue Cross for health benefits; instead, they enroll in the Service Benefit Plan through the United States Office of Personnel Management (“OPM”) and their federal employing office. The Service Benefit Plan in this case was created by federal government Master Contracts between OPM and Blue Cross and Blue Shield Association (“BCBSA”), pursuant to FEHBA. (Doc. No. 1-7; Doc. No. 1-8). In contracting with OPM, BCBSA acts as an agent for and on behalf of local Blue Cross and Blue Shield companies that administer the Service Benefit Plan in their area. The Bradys' health insurance plan was administered in Massachusetts by Blue Cross and Blue Shield of Massachusetts, Inc. and in Florida by Blue Cross and Blue Shield of Florida, Inc.

         FEHBA and the regulations implementing it set forth a comprehensive framework for the supervision and administration of the Service Benefit Plan. Under FEHBA, OPM is vested with the sole authority to contract for the provision of health plans and to determine the benefit structure of each plan. 5 U.S.C. § 8902(a), (d). OPM prescribes the necessary regulations, which includes providing for the beginning and ending dates of coverage of employees, members of their families, and former spouses. 5 U.S.C. § 8913(a), (c). The Master Contracts between OPM and BCBSA state that the following laws and regulations “constitute part of [the Master Contract] as if fully set forth herein”: (1) the provisions of Chapter 89 of Title 5 of the United State Code; (2) OPM's regulations set forth in Part 890 of Title 5 of the Code of Federal Regulations; and (3) Chapters 1 and 16 of Title 48 of the Code of Federal Regulations. (Doc. No. 1-7, § 1.4(a); Doc. No. 1-8, § 1.4(a)).

         B. Coverage for Family Members

         The regulations provide that a member of one's family includes their spouse and any unmarried, dependant children that are under the age of 22 or disabled. 5 U.S.C. § 8901(5). The regulations provide that coverage for a family member terminates on the date on which he or she ceases to be a family member, which in this case, would be the date of the Bradys' divorce. 5 C.F.R. § 890.304(c)(1). Likewise, the regulations address dis-enrollment of ...


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