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  1. #1
    JamesH33 is offline Junior Member
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    Opt-out Of Contributory Health Insurance

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

    Are companies required to give you the option to opt out of Contributory Health insurance? More specifically can an employer have a policy that requires employees to be on their self insured health plan? Thanks.What is the name of your state (only U.S. law)?
  2. #2
    cbg
    cbg is offline Senior Member
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    I had always understood that employers could not require you to participate in a contributory plan, but I have to confess that I cannot provide you with any law that says so. Will your employer allow you to opt out if you can provide proof of other coverage? That would definitely hold water legally if they will.
    Two things I am tired of typing: 1.) A wrongful termination does not mean that you were fired for something you didn't do; it means that you were fired for a reason prohibited by law. 2.) The above answer, whatever it is, assumes that no legally binding contract or CBA expressly says otherwise. If it does, the terms of the contract apply.
  3. #3
    lkc15507 is offline Member
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    Quote Originally Posted by cbg View Post
    I had always understood that employers could not require you to participate in a contributory plan, but I have to confess that I cannot provide you with any law that says so. Will your employer allow you to opt out if you can provide proof of other coverage? That would definitely hold water legally if they will.
    I agree. Good question by poster. My response is experience based and not based upon any actual regs I can find either. But, my thoughts on this are that there simply is not any reg or law to prohibit nor allow opting out of either a contributory or non-contributory health plan. I think this is determined by the insurer / employer contract (employer only if self-insured). The basis being avoidance of becoming at cross purposes with other regulated areas such as adverse selection.

    For practical purposes this would occur most often if one has another preferable health plan available. In that event my experience tells me that manay insurers would allow opt out of a non-contributory plan upon proof of other health insurance (OHI). Reason being although the percentage of participation is very high for a non-contributory plan, OHI available is not likely considered a "decline".

    For a contributory plan the percentage of participation is usually much lower than for a non-. Therefore it is quite likely the employer/insurer contract will allow for opt out. BUT, for anyone considering this please be aware that health plans are often wise to opt outs and will reduce benefits for a dependent spouse that has employer group plan available. IE, be sure that the plan you wish to be a dependent on does not reduce benefits below the level available with your own employer plan.

    Best to you, lkc15507

    PS For those looking to opt out of a Non contributory plan, Section 125 does not require the employer to otherwise compensate for the opt out. Also the above answer is based upon status prior to full implementation of PPACA. As PPACA regs are still being interpreted and written there is no telling how the above will change with its full implementation.
    Last edited by lkc15507; 05-04-2011 at 09:32 PM.
  4. #4
    swalsh411 is offline Senior Member
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    Quote Originally Posted by Tryingtowin View Post
    Well, they certainly need your approval to take out funds from your paycheck...never heard of a company trying to force you to get their insurance. (some ask for proof of insurance & I think that this goes to far).

    Its none of their business unless you want their insurance.
    It is entirely their business whether or not employees have health insurance. If one is not ensured they are less likely to seek preventative care and medical attention and this can have a direct impact on productivity, sick time, attendence, strees, etc. A person is free to not work for an employer who feels this way however.

    If you make agreeing to the deduction a condition of employment that solves the other issue as well.
  5. #5
    lkc15507 is offline Member
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    Little bit confusing to me as I see tryingtowin is quoted by swalsh411 yet I don't see the original post by tryingtowin. Assuming that quote is correct, I have one response: You need their (employer) approval to have the job. Absolutely in the situation of an employer not allowing opt out of either type of plan, contributory or non-, one may well not have the job if they do not comply with the rules of the health plan.

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