health insurance

[reizel]

What is the name of your state? What is the name of your state? illinois

my employer is self-insured. in the employment contract it states that the employer will pay full single coverage for all full-time employees who are covered by the employer's medical-surgical programs.

do i have a right to decline my employer's insurance? can they use my decline as a means to terminate my employement for breaking the contract (even though it is not specifically stated so in the contract)?

can an employer mandate that employees use their insurance as a condition for employment?

if yes, is the employee still bound by that condition if he or she were first notified of this months after beginning full-time employment?

 

[cbg]

It is impossible to give you an absolutely definite answer without seeing the insurance contract. I can give you some probabilties, however.

Unless the contract that your employer has with the insurance carrier guarantees that 100% of employees will be covered, then I don't see why anyone would care whether you declined the insurance or not. Even if there is such a clause, most of the time there is a provision to exclude employees who can prove that they have other insurance. If your employer is self-insured, it's unlikely that there is such a guarantee; such 100% coverage promises are most often included in fully-insured contracts.

Yes, you may decline the insurance if you choose. You may be required to provide proof that you have other insurance and that is legal.

Legally, yes they can terminate you for declining the insurance. However, it is EXTREMELY unlikely that they would do so.

Again, in the strictest legal sense they can require you to take the insurance as a condition of employment, but I don't see them doing so. Contrary to what you appear to believe, most employers are NOT anxious to include all employees on the plan. It does not benefit them; they receive no discounts or benefits for forcing employees who do not want coverage to take it. Most employers are perfectly happy to have a certain percentage of employees take their spouse's or parent's coverage.

What has anyone said to you, to make you so concerned that you will be forced to take coverage you do not want?

 

[reizel]

They have told me it is in my contract of employment that I have to have it. However, it is worded only that the employer shall pay full coverage, not that the employee necessarily has to accept it. I have notified them that I wish to decline it. I have much better insurance coverage elsewhere, and I do not wish to use the one provided by my employer. My employer is giving me the run-around, claiming they need to meet with members of the union about this issue.

I have never seen the insurance contract my employer has with whatever agency is handeling their insurance, so I cannot answer your question as to the insurance carrier's 100%guarantee.

Nevertheless, the fact that I have to accept their insurance is not explicitly stated in my contract. How so can my decline of their insurance be considered a breach of that contract? Is there any form of protection or law I can look into to defend my right to choose among which health care provider I wish to use & pay?

 

[cbg]

Ask the Illinois Insurance Commission. Insurance law is for the most part state regulated, and I have no experience with Illinois law.

 

[lkc15507]

reizel:

The thing that I am unclear about is that you mentioned 'union' in your last post. Although I find it odd that an employer would insist on your using the health insurance offered and consider it a breach of your employment contract to waive that insurance (as cbg said, I would think they would welcome not having to cover an employee with potential claims.) Many times union contracts will differ from the regular employment conditions of a given employer. I suggest you look to the union contract with your employment for your answer. ie, if an employer employs both non-union and union employees, different definitions of 'active employee' and / or 'employment' may apply. Are you a union member? Many employers employ both union and non-union employees. Make sure the employer is applying the correct terms of employment.

Lastly, although I have no idea about your other coverage, many policies, (including self-funded), provide coordination of benefits between the policies. As most policies have some amount of out-of-pocket expense, coordination of benefits is usually a good thing. Out of curiosity, why are you so opposed to accepting additional coverage when that premium is paid by the employer?

Best of luck.

lkc15507

 

[reizel]

Health Insurance

Thank you to those who have responded to my question.

In answer to the "union" question, all I can say is that my contract is very vague on this issue. It states that the employer will "pay full coverage for full-time employees who are members of the medical-surgical programs." As you can see this is not very explicit as to whether or not employees have to accept the insurance offered by the employer.

I prefer not to accept my employer's insurance (even though they pay 100% of the premium) because a) I would have to pay an annual deductable of several hundreds of dollars before they pay a penny towards the services I require, and b) they pay at most 90% for many of the services I feel I will need in the next few years, which means I would have to pay more out of my pocket for the priviledge of having their insurance.

People with whom I have spoken at my place of employment have given me conflicting information in response to my question. One informed me that I have to have their insurance, it is in my contract (I read through my contract; unless she is refering to that one vague sentence, nowhere in my contract is what she claims stated.). The second person I spoke with told me that I don't have to accept anything I don't want. However, it has to be provided to me, or my employer would be in violation of the contract (which is ridiculous to me. They provided me with the information, albiet months after I was hired. I would not hold them accountable for declining their insurance.).

If I were to use my employer insurance in conjunction to the one I already have, the company that my employer uses will pay at most 80% of what they designate as "reasonable cost". I am aware that my other insurance would be obligated to pay the rest if it is stated in their contract as services they would normally cover. That doesn't mean that they would necessarily be willing to pay all or even part of the difference my other insurance wouldn't cover. It means I would have to take a lot of time contacting both companies to ensure all or most of the bill would be covered, when I should only have to pay one to have this done for me. (Not to mention the reality that my current insurance may choose to drop me for having coverage elsewhere.)

Economically, it is to my advantage to stick with the insurance I already have.

Hence my dilemma.

I will consult the Illinois Insurance Comission for information specific to the state I live in.

Many thanks.