Is employer responsible?

[JLLee]

What is the name of your state? Indiana

If an employer has his company pay 100% of his own medical insurance does he have to provide medical insurance for his employees?

Case...DH had heart attack in April 2007. When DH took job in April 2006 employer said he would provide insurance, but never did. He had insurance for himself, had been having company pay for it for 10+ years, but never supplied it for his 3 employees.

We were given help from the hospital on some of the bills due to not having insurance but still have about $6000 that were not covered. They covered 90% of the bills through the hospital. We are having a VERY hard time paying them.

We are now facing the bills going on our credit report and we do not want this to happen. Is the employer responsible for any of the bills since we have witnesses that he would provide insurance? Witness include employers brother, employers girlfriend, employers secretary and ex-business partner.

[cbg]

If you are asking whether or not there is a law that an employer cannot provide insurance for himself without also providing it for his employees, no, there is no such law. Nor does he have any legal liability for your medical bills if he does not.

Whether or not you have any recourse depends on whether or not you have a contract that guarantees insurance; also what the plan document says.

[john frankiewic]

I would disagree. In MA, and I assume in other states, if the owner is on a group plan and the company is paying for it he has to provide the same options for each employee. In addition, the contract he signed with his carrier has a discrimination clause, he can not provide insurance to some and not others and that includes an owner. In the example mentioned he is committing fraud.
Also in MA he could not pay more of the premium for himself or anyone else than he pays for an employee, again discrimination. You are partially correct in that there is no law requiring that a business provide health insurance. But once a plan in place it has to be offered to everyone eligible consistently.

[cbg]

MA laws on health insurance are different than those in other states, though, John. I'm in MA too but the OP is not. MA law does not apply to her. I have several years experience with small group plans in other states - I am not assuming, as you admit you are.

[john frankiewic]

I checked a few of the carriers contracts in Indiana and carriers there require a 75% participation of elidgle employees in a group plan. If the owner provides coverage for himself and not the 3 employees, he does not meet the 75% requirement. Every year on renewal he would be asked if he is still in compliance and if he says he is and clearly he is not. Fraud.
Maybe you should make sure your E&O is up to date.

[cbg]

What a carrier contract requires is not a law.

[moburkes]

Originally Posted by john frankiewic

I checked a few of the carriers contracts in Indiana and carriers there require a 75% participation of elidgle employees in a group plan. If the owner provides coverage for himself and not the 3 employees, he does not meet the 75% requirement. Every year on renewal he would be asked if he is still in compliance and if he says he is and clearly he is not. Fraud.
Maybe you should make sure your E&O is up to date.

Well, I guess that I need to check mine as well. Please post the relevant statute.

[ecmst12]

Originally Posted by john frankiewic

I checked a few of the carriers contracts in Indiana and carriers there require a 75% participation of elidgle employees in a group plan. If the owner provides coverage for himself and not the 3 employees, he does not meet the 75% requirement. Every year on renewal he would be asked if he is still in compliance and if he says he is and clearly he is not. Fraud.
Maybe you should make sure your E&O is up to date.

How do you know OP's employer is even ON a group plan? If this is a small business, the employer/owner could have simply purchased an individual plan for himself, and paid for it as a business expense for the company.

OR, if it is a group plan, "eligible employees" could be defined as management only, meaning the other 3 employees are not eligible. You're making a lot of assumptions.

[Betty]

John, you are wrong. There is no law as stated previously that says the employer can't have ins. on himself if he doesn't have it on his employees.

[TinkerBelleLuvr]

If an employer has his company pay 100% of his own medical insurance does he have to provide medical insurance for his employees?

It is quite possible that the company is paying for the insurance, but it considered as part of the 'draw' for the company owner. The owner would then have the insurance payment be taxable income. Employees never have the full picture.

[TIMMAAYY]

John,

The key word is employees. More specifically, eligible employees as mentioned above.

An employer can have insurance for himself and nobody else.

An employer can have insurance and offer something similar or completely different to one class of employees and not another.

Also, small group rules are different when you get to groups under 4 or 5 with most carriers, who require that ALL eligible employees must be in the group plan. This is not a law, it's a carrier rule, and as such it's rarely enforced to it's full extent for very small groups ( 2-5 ).

And, you can get down to 50% of eligible employees with some carriers, as 25% can not do anything at all, and 25% have to be "valid waivers"... spousal coverage, other group coverage, whatever their terms are for that carrier.