can we do this?

Belindar · March 2004

Is it legal to not offer group health insurance to an employee if they currently have coverage elsewhere? We recently offered a monetary incentive to any employee that dropped coverage because they were covered elsewhere and want to tell any new employees that they are not eligible for the group health plan if they have other coverage.

cebudragonlady · March 2004

As long as everyone is treated the same, I don't see a problem. Suggest that you have your employees that want the monetary incentive to sign a document stating that they understand that they cannot change their minds until the next Open Enrollment period.

Chari

JM in ATL · March 2004

What are you going to do if the employee takes the money and drops insurance but then states they want to re-enroll during open enrollment. Are you going to make them repay the incentive?

What if they lose the other coverage and took the incentive? Such as they have other coverage at a spouse's job and the spouse loses employment.

This just doesn't sound like a good idea to me. If you pay for the benefit in full then I can understand where you are going with this, but it just doesn't sound like a good idea to me. It sounds like there would be more problems then solutions here.

And your insurance carrier, are they going to let people opt out of the plan during a non-open enrollment period regardless if they have other coverage or not?

Out of curiosity, why don't you want your employees to take coverage if they are covered somewhere else?

lnelson · March 2004

"Is it legal to not offer group health insurance to an employee if they currently have coverage elsewhere? ..want to tell any new employees that they are not eligible for the group health plan if they have other coverage."

I am not sure of the legalities BUT just because they have coverage somewhere else you cannot deny them your coverage. It has to be their decision to waive your insurance and as another poster stated I would get a written waiver from them stating they do not want your insurance.

Lisa

hrlady42 · March 2004

We currently do this as an incentive program. We pay full coverage for our employees.

If they are covered by another insurance (their spouses) we offer them the opportunity to waive our insurance and receive 25% of what their monthly premium would be.

The waiver must be signed by their spouse and notarized. We ask them to furnish the name and policy number of the other carrier.

If the spouse loses coverage them that is a qualifying event and they can return immediately back to our insurance.

They CANNOT, however, return just because they want to until the next open enrollment period.

We have been doing it for three years and have had no problems.

CAUTION: In Ohio we cannot let someone opt out for any type of governmental insurance. It is illegal.

ladyzuesse · March 2004

My spouse's company offers an "opt-out" bonus (about 30.00 a pay period) and he works for a multinational government contractor. He collects the opt out because the insurance at my company is much less expensive. We do carry some insurances with his ER because my ER does not provide them.

I think you if you offer ee's an opt out incentive, it should be reason neutral - some ee's here have coverage under another plan, others are retired military - and qualified changes in coverage are dealt with routinely.

Why are you asking for policy numbers and carriers for spousal coverage? What are you doing with that information? we ask for other coverage information for COB, but not if they decline coverage.

Tammy

Belindar · March 2004

Tammy,

We are not asking for that information. If they opt out that is all there is to it. We feel that we left the amount small enough that they would not simply drop all coverage in order to collect the extra money.

Belinda

Sandy · March 2004

We currently offer our full time employees an insurance bonus if they choose not to take our medical and/or dental insurance. On both enrollment forms, there is a section in which an employee can waive the insurance but must sign off on it (usually there are a couple of boxes that ask why the person is waiving such as spousal coverage).

The advantage to this is that our company also pay 100% coverage. If an employee does not need the insurance, they can receive an additional monetary monthly amount while the company saves on the monthly premium. Employees can elect to waive off on Medical, Dental, or both.

An employee can come back on our plan at either open enrollment or if any qualifying event (such as loss of spousal coverage) occurs.

It has been viewed by both the company and our employees as a win-win situation.

can we do this?

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