Health Insurance Quotes
Group health plan choke holds: Can they make me do that?
Almost half (49 percent) of the U.S. population has health insurance through an employer-sponsored plan, whether as a worker or a dependent, according to the Kaiser Family Foundation. If you buy your family's health insurance from your employer, you may have questions about your rights -- and how the implementation of the Affordable Care Act will affect you.
We asked experts to help us out: Andrea Kinkade, president and benefit adviser of Kaminsky & Associates Inc. in Maumee, Ohio, a member of United Benefits Advisors, and attorney David B. Wilson of Hirsch Roberts Weinstein in Boston, an expert in employment law.
1. Can my employer make me buy the health plan at work?
No. Employers can't require anyone to elect coverage, with a couple of exceptions.
Your employer could require you to take the company's group health insurance if your employer pays 100 percent of the premium. If that's the case, your employer's insurance carrier may require all employees and their eligible dependents to enroll in order to spread the risk.
In today's marketplace, it is not likely the employer will pay 100 percent of the premiums but, if it did, why would you want to decline coverage?
Also, some employment contracts may stipulate you participate in the health plan. If you signed such a contract when you were hired, your employer can require you to opt for coverage even if it means you have to pay part of the premium.
Wilson says that if you decline benefits, your employer may require you to sign a form confirming that you have done so, to protect both you and your employer.
2. Can my employer require me to add my spouse to my health plan at work?
No, employers can't require anyone to elect coverage, whether it's the employee or their dependents. That includes the employee's spouse, Kinkade says.
Wilson says it's not likely an employer would want to require you to add a spouse to your health insurance plan because it would cost the employer more. Most employers pay some percentage of the premium.
Some employers may offer you money not to enroll your spouse. "Your employer may say, 'We'll give you $100 a month if you don't put your spouse on your plan,'" Wilson says. "It's cheaper for the employer to give you $1,200 a year than to pay a percentage of the health insurance for your spouse." If your spouse can get affordable health insurance elsewhere, it could be a good deal.
3. Can my employer refuse to let me add my spouse if my spouse can get coverage through his or her work?
The answer depends on where you live.
In most states employers can refuse to cover spouses if the spouses are eligible for health insurance through their own workplaces. A very few states say spouses can't be refused coverage, Kinkade says.
The Affordable Care Act mandates that employers provide health insurance to employees and their dependents beginning in 2015, but the law only defines dependents as children. Spouses will not be defined as "eligible dependents." Once this provision of health care reform takes effect, employers will not be required to extend coverage to spouses regardless of any other coverage they might have.
That's not to say that employers will be dropping spouses left and right; the effect remains to be seen.
4. Can my employer make me tell them if my spouse is eligible for a plan at his or her work? Can my employer demand details of the plan for which my spouse is eligible?
Yes, it can, says Kinkade.
"If your employer has a policy that requires verification of available benefits, it can require you to provide this information," she says. Employers can ask you for information verifying your spouse's eligibility at his or her work and for details of the benefits.
Kinkade has found that some employers work on the honor system: They expect their employees to volunteer if their working spouse is eligible for benefits through his or her employer. Others may spot check to see if the spouse has coverage elsewhere, and still others may require their employee to complete a form declaring whether or not the spouse is eligible for coverage elsewhere.
5. I work for the same place as my spouse. Can our employer make us buy two plans rather than one family plan?
Yes, Kinkade says. "This is an employer policy and employers can require you to take two plans based on the overall cost-effectiveness of two single contracts versus an employee/spouse policy," she says.
Most employers will look at their rate structure and decide what's cheapest. Do they offer only single or family options? Do they also have employee/spouse or employee/children coverage?
"We have seen where a husband and wife wanted to split their [health insurance] contracts and their employer said no," Kinkade says. "They can require a family contract so it doesn't cost the employer as much."
As a practical matter, Wilson says, employers are going to require whatever is the cheapest for them. And employees would want to enroll in whatever way means the least cost for them as well.
Consider whether your employer offers a health savings account where you can put pretax dollars to cover your out-of-pocket medical expenses. Because the amount you can set aside for your HSA is capped, it may pay to enroll separately.
Wilson notes that laws can vary from state to state and if you're unsure, you can check with the state department of insurance where you live. If you work for a large company that is self-insured, it is regulated by federal, not state, insurance laws. The Affordable Care Act (aka Obamacare) is a federal law.
More from Beth Orenstein here