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Mandatory Participation in Group health plan in CA

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What is the name of your state (only U.S. law)? CA

Is it legal for a California employer to mandate its employees to participate in their health plan when they cannot prove they have other coverage elsewhere? And is it legal even if the employee has to pay a portion of the premiums?
 


cbg

I'm a Northern Girl
It has always been my understanding that if an employer pays 100% of the premium, they can mandate that an employee participate in the health plan, but if part of the premium is employee-paid, they cannot.

However, I cannot point to any law, either Federal or state, that says so.

You might want to ask the state insurance commission.
 
You're asking the question the wrong way. Can an employer FIRE a person for not having insurance?

Yes.
That was not my question. My question was can an employer mandate and employees participation in their Health Insurance program if the employee cannot otherwise prove they have coverage elsewhere (via spouse, medicare and/or medicaid)...EVEN if such participation would require the employee to pay a portion of the premiums based on employer policies. For example, a less than 8 hour employee has to pay a prorated portion of the premium based on their assigned hours. (8 hour employees do not pay anything, anything less than 8 hours, they pay a pro-rated amount. Such as, a 6 hour employee would have to pay 25% and the employer pays 75% of the total premiums). There is an opt out provision for those who can prove they have other coverage...and only if they show proof of other coverage.
 

Zigner

Senior Member, Non-Attorney
The answer is the same. They cannot "force you", but the CAN fire you for not.
 

pattytx

Senior Member
We don't know. As previously advised, contact the insurance commissioner for the state and ask them. If there IS any law regarding mandatory enrollment if the employee is paying part of the premiums, they should know.
 

tranquility

Senior Member
An employer does not have the power to force you to have insurance. They do have the power to fire you if you do not.

It is in the employer's best interest to have employees insured. They are less prone to sickness and disease which would cause an employer to have to spend money retraining another. To prevent the ability of an employer to fire you, you have to claim the firing is in violation of a specific statute or constitutional provision or was a "tortious discharge in contravention to public policy". I suspect it will be very difficult to get a court to find mandating a person to have health insurance is not in the public's good.

The privacy issue for how they make you prove you have insurance may be an entirely different matter.
 
Thank you. I have researched and researched and cannot find a law prohibiting employers from mandatory coverage. The employer does allow opting out as long as employee shows proof of other coverage. Either a copy of Insurance card or a letter from the other employer/insurance co stating they are covered.
 

tranquility

Senior Member
Either a copy of Insurance card or a letter from the other employer/insurance co stating they are covered.
And, here is where the problem for the requirement may lie. An argument may be made that such a requirement is in violation of your rights to privacy under the California constitution.

I don't know if you'd find an attorney who would want to make such an argument, but that's the issue I'd spend time researching if I were so inclined.
 

cbg

I'm a Northern Girl
I'm not so sure that this is as clear cut as all that. I think it might be walking a very fine line with regards to ERISA.

Many, many policies allow an opt out if you can show proof of insurance. There's no issue with that. But I'm not at all sure that it's acceptable to force participation unless the plan is 100% employer paid.

I still recommend contacting the state insurance commission.
 

tranquility

Senior Member
What is the line? What is the issue with ERISA?

For employers over 20 people, there is a requirement in the City of San Francisco to either have the employer give some level of contribution to the employee's health care or pay an amount to the city. To remove the employee from the requirement, there is a provision in the law in which the employee can submit a waiver to the employer (who sends it on to the city) which says he is otherwise covered by another employer's plans AND that he voluntarily agrees to relinquish his employer's benefit.

So far it seems to be passing up to the level of the 9th circuit.

GOLDEN GATE RESTAURANT v. City and County of San Francisco, 546 F. 3d 639 - Court of Appeals, 9th Circuit 2008

While we can distinguish, I think that if the government can pass a law, an employer can "pass" a similar requirement. Say in the above an employee were to refuse to sign such a waiver and did not pay for the employee's share of his employer's insurance, thus costing the employer a fee to the city. The employer could do nothing?
 

cbg

I'm a Northern Girl
ERISA does not permit an employer to fire an employee because of their use of health benefits. Firing them because they do not have health benefits seems a little too close to that for me.

Please note that I am not saying it IS illegal. I'm saying I'm not as certain as everyone else that it is legal. Can a call to the insurance commission really be that outrageous a solution?
 

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