Mandatory Participation in Group health plan in CA

[tranquility]

San Francisco is in California, darlin'.

The case is all about ERISA and how the law does not violate it. Employee is covered by insurance (Paid or partially paid by employer or the employee is covered by another employer AND submits a waiver to any rights.) or the employer pays a fee to the city. I don't claim the case covers the OPs issue. However, I do claim it covers the ERISA issue for California employees. (At least up to the Federal Appellate level. We'll see if the Supremes take it up.)

 

[cbg]

There's a whole lot of California that isn't San Francisco. Do we know, for certain, that the poster is in San Francisco? Or possibly elsewhere in California, where San Francisco mandates do not hold?

And if you are certain that ERISA does not hold, I am not.

 

[tranquility]

Really? Sigh. I'll spell out the linkage here.

The City of San Francisco has mandated pretty much what the OP's employer has. Employers (Well, the Golden Gate Restaurant association, but lot's of others joined in the briefing.) didn't like that so made the argument it was illegal under ERISA. The appellate court said it was not. The case's discussion was long and difficult and I didn't understand all of it, but the bottom line in a decision which is precedent, hence the LAW in all of the 9th circuit is such a scheme is not in violation of ERISA. True, it was the San Francisco ordinance which was the source of the case, but the case covers all of the 9th circuit--which includes California. Which, not coincidentally, is the OP's state.

We can distinguish the case from our facts. But, a law mandating almost exactly what the OP's employer wants to do has been found to not be in violation. The big jump from that is, can the employer do anything against an employee who would cause the employer to pay a fee to the city? You see, it is the same question EVEN WITHOUT THE ORDINANCE. There is no distinguishable difference between those things. I find it difficult to believe it is legal to "mandate" something without it being legal to take acts to enforce it.

Your opinion is not without merit as, because of the case, there is a circuit split regarding the pre-emption issue between the 9th and 4th circuits. Which is why the Supreme Court may very well take it up. But, as of right now, I believe the law in the OP's state is that such a scheme does not violate ERISA. It is only my rank and uneducated opinion (I don't claim this next part is the law.) that employers can take action against an employee who doesn't do as mandated.

 

[cbg]

The sarcasm was not necessary, friend. I've worked with ERISA benefits for 30 years. I'm not just talking out of my hat.

 

[tranquility]

Sarcasm often begets same.

I understand we speak more carefully when talking about our true expertise. My posts in tax and in trusts and estates sections are far more circumspect than in other areas. I never said you were talking out of your hat. However, when I am challenged in the areas of my expertise, I usually back up my opinion with specific on-point references. I accept that is not everyone's course.

I find the forums greatest value comes from when differing members debate and challenge each other. No one knows everything and only after back and forth does FreeAdvice reach what I believe to be a remarkably accurate sense of what the law is--even when we really can't apply it directly to the facts an OP presents.

Pointing out we have a difference of opinion does not aid that process. Pointing out the specific difference at least gives one something to discuss. I did that. Then opinions from members I have some respect for tried to say my opinion didn't apply here as my argument was based on a San Francisco ordinance case and we don't know that the OP was from San Francisco. Now, I don't know much about ERISA, but I do know how to cite precedent. I KNOW we can distinguish the case. It's not perfect for our facts, but it is pretty darn good to dispute the specific point brought up.

Give a good reason to distinguish and debate can continue. Tell me we don't know if the OP is from San Francisco and...

 

[pattytx]

And I was born and raised in California, "darlin'", so I know where San Francisco is. I also know that Fresno is NOT San Francisco.

 

[Concerned33]

Thank you for all your information. I am not in San Francisco..just to be clear on that. But am I to understand that the court in California has upheld an employers right to require participation in their health insurance program when they do not have coverage elsewhere?

What a great discussion! I have gained valuable information from reading the posts! So thank you all!!! If anyone has anything else to add, I look forward to reading that as well!

 

[tranquility]

Nobody understands good sarcasm any more.

How very true.

 

[Concerned33]

one more question....

Would Medi-cal be considered "other health coverage" for opting out purposes?

 

[pattytx]

My understanding is that Medicaid is always secondary.