Health Insurance Discriminiation

[xanbabe]

What is the name of your state? New York

Hopefully someone can answer this question regarding health care for me. My friend works for a small company of approximately 9 employees. Some are offered health insurance and some are not, my friend is in the "not" category. I understand there are no provisions for a business to offer all employees health insurance, but in this case the reason he is being told that it is not offered to him is because he has to work "full time" hours to be eligible. He is scheduled for a full 8 hours each day (8 1/2 if you want to get technical to provide for lunch). He does frequently leave work early on fridays for an ongoing medical appt he has to attend, but he is scheduled for 40 hours each & every week and his employer allows him this time unpaid. Him & at least one other service tech have not been offered it, yet another, who happens to be the bosses son as well, have it. They are all considered service techs. I believe this boss is confusing what "full time" hours really means, he's thinkin that if he doesn't actually work the hours he's not "full time", in my understanding, it's the hours you are scheduled for. Can someone please clarify if he should be eligible or not. Thank you.

 

[moburkes]

He is not required to be offered health insurance.

 

[xanbabe]

I understand he's not required to be offered it. But from what I've read on other posts, if the employer chooses to offer it, it has to be done equally, through the classes/requirements the employer decides to offer it to. Maybe I didn't explain myself properly, but maybe the question should have been, if the employer has chosen to offer health care, and it is offered to all full time status employees, and all the service techs are all full time status employees, should it have to be offered to all the service techs (my friend is not the only one who would like ins but not offered/told not eligible)? Like I said before, he is the same job title & hours as the other person who has been offered it. And he was told that he was not because according to his boss, he does not work full time, even tho he is scheduled for 40 hours a week in addition to being put on call frequently. To me, it seems that the employeer is only saying that he isn't full time to avoid having to give him insurance. He was hired as full time, his boss tho is counting time off of work (ie dr's appts, sick time) as him not working full time hours.

Am I correct assuming under the above scenario, employer offers health care to all full time regular status employees, then each and every full time regular employees has to be offered??

 

[moburkes]

If he regularly works less than a 40 hour work week, then he is not required to be offered insurance.

 

[ecmst12]

He has to actually work the 40 hours to qualify. If once in a while he was a few hours short that would be one thing, but if he works less then 40 hours every single week(or even most weeks), that would definitely disqualify him for benefits, if the requirement is that he work 40 hours a week.

 

[xanbabe]

Ok, but that still doesn't answer the question.

Am I correct assuming under the above scenario, employer offers health care to all full time regular status employees, then each and every full time regular employees has to be offered??

He is regularly scheduled as full time & does work 40+ hours a week. That should classify him as full time & he was hired as full time, with no known status change to part time. His boss has never informed him he was switched to part time status. The time off i talk about him taking is allowed and preapproved by the employer (we're talking 1/2 to an hour), it is so he can attend a workers comp mandated dr apt for his back. And he doesn't always take this time, if he is in the middle of a call, he finishes out the day. His employer cannot hold this against him since it is workmans comp related. This is the issue. Irregardless of the time taken off for this workmans comp mandated appt, he is still considered a full time employee, scheduled for on call time (just like every other full time tech there, which frequently puts him into overtime). What it seems you're telling me then is that an employer can bounce your status around as he pleases to avoid payment of benefits?? Last i checked, most health plans do not constitute temporary changes as loss/gain of eligiblity, ie a full time employee taking a day off, a part time employee working extra hours. So your answer is confusing me. It doesn't answer the question that if the employer chooses to offer health care to all full time status employees, then each & every full time employee should be offered it?? If I'm understanding correctly, the only way his employer would be able to not offer it to him, if the insurance is being offered provided you are a full time employee, is if his status is changed to part time??

 

[ecmst12]

You really need to see the plan document to know exactly what the requirements are to be eligible for coverage. If they say he has to work 40 hours a week (what he's scheduled for doesn't matter, only what he actually works) and he only works 39.5, then he doesn't qualify. But without knowing what the specific requirements are, we're all just guessing.

 

[xanbabe]

I believe it states full time status, not hours, but he's checking into that to be sure. So he'd still be excluded if the time he does miss is workers comp related??

 

[pattytx]

Not necessarily. Again, the plan document rules are the answer here.

Now, if the absences are also FMLA-qualifying, then you have a different situation.

 

[moburkes]

Why did you originally state that he doesn't work 40 hours a week?

 

[xanbabe]

I probably didn't have enuf coffee in me when i first wrote it, that's why i elaborated. He does work 40+ hours regularly, minus the hour or less he leaves early on fridays to go to his chiropractor, which he has to go to on a regular basis or he loses workmans comp coverage for it (its an injury from a previous job). His boss has always allowed him to go for the most part, unless they're super busy or he's not finished with the job he's currently on, then he skips it. Other than this, or personal/vacation time (which is usually scheduled in advance), he works full time. So i'll wait to hear from him about getting the plan docs. He's supposed to be trying to get those & get a definate answer as to if his boss has him as full time or part time status. So once he gets those, we'll probably have more questions. Thanks.

 

[pattytx]

So, if the employer meets the criteria to be covered by FMLA, has he applied for intermittent FMLA?

 

[mjcrules]

One major question: Is there a health insurance plan offered to employees by means of the employer owning and maintaining a group health insurance policy? I have seen some small employers offer to pay for the employees health insurance as a means of compensation. The employee owned the policy not the employer in these situations.

 

[moburkes]

One major question: Is there a health insurance plan offered to employees by means of the employer owning and maintaining a group health insurance policy? I have seen some small employers offer to pay for the employees health insurance as a means of compensation. The employee owned the policy not the employer in these situations.

Yes. But, what does that have to do with the OP? If you'd like to ask your own questions, you should start your own thread.