United States District Court, M.D. Florida, Tampa Division
MICHELLE A. BRADY, Plaintiff,
SHAUN J. BRADY, ET AL., Defendants.
C. BUCKLEW JUDGE
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.
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
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. 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
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.
result, Plaintiff's health insurance coverage was
terminated retroactively to the purported date of the
Bradys' divorce. 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.
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.
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.
The Service Benefit Plan
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.
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)).
Coverage for Family Members
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 ...