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Health Insurance Benefits Question

Discussion in 'Employee Benefits, Pensions' started by amployed, Jan 26, 2013.

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  1. amployed

    amployed Law Topic Starter New Member

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    I work in a corporation that has about 400 employees. I don't have health insurance right now. I think that the company offered some employees health insurance. Somebody told me that I should confront HR because they said I should have been asked if I wanted health insurance and sign that I didn't want it. They said that it is a law or some requirement. Does anybody know what law this could be. I want to be prepared before I talk to HR.
     
  2. DAWW

    DAWW New Member

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    There is a federal law called ERISA. It does not require employers to offer health insurance, but if the employer chooses to offer health insurance, then under law, the employer is required to:
    - Have a formal published plan spelling out the rules specific to the employer.
    - The employer is required to follow the specific rules in THEIR published plans to the letter. Different companies have different plans and no one on this website is likely familiar with YOUR employer's plan rules.
    - The employer is legally required to give a short verision of the plan, called a Summary Plan Document, to any employee who asks for one.

    You need to ask your employer for their SPD. Then read it. And no, we cannot do this for you.

    Unrelated to the federal requirments, your state may or may not have imposed some additional requirements.
     
  3. cbg

    cbg Super Moderator

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    In addition to DAWW's correct response:

    It is a myth that if one employee is offered health insurance, all employees must be. That is an oversimplification of what ERISA requires. The plan document DAWW refers to may, quite legally, say that certain classes of employees are eligible for or not eligible for health insurance. For example, where I work we have 26 different classes of employees. Of the 26, probably 20 are eligible for health insurance. The other 6 are not, and the plan document specifies this. In addition, even employees in the 20 eligible classes have to meet one of two criteria - either an hours requirement or a wage requirement - to be offered it. The plan document specifies this as well. Employees in the 20 eligible classes who do not meet either of the two criteria are not offered health insurance, and that is legal.

    My state has arguably the strictest requirements of any state in the US with regards to employer-offered health insurance, at least for this year. Come 2014, the rules change. But for now, we remain one of only two states that require employers to offer health insurance at all (the other is Hawaii).

    IF you are of an eligible class of employee AND you meet all the eligibility criteria as defined by your employer's plan document, then your employer must offer you health insurance. If you are NOT an eligible class of employee OR if you do not meet all the eligibility as defined by your employer's plan document, then your employee not only need not, but may not, offer you health insurance.

    As DAWW said, only your employer can tell you if you are an eligible class of employee or if you meet all the eligibility criteria.
     
  4. amployed

    amployed Law Topic Starter New Member

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    Wow! Thank you for so much information in your reply. It will take me a little while to read and understand it but I hope I can ask some follow up questions if I need. :)
     
  5. cbg

    cbg Super Moderator

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    Absolutely. That's what we're here for. And this (employer-sponsored health insurance) is what I do for a living .
     
  6. DAWW

    DAWW New Member

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    One last thing. Is it possible for an employer to have a plan which is illegal on it's face? Sure. Just (for example) violate Title VII by excluding employees by race or gender. HOWEVER, if the plan is legal, and most plans are, then the really big question is whether or not the employer is following the exact requirements of their published plan. Why that sounds like a no-brainer, there is actually more then one meaning to the phrase "no-brainer". I have worked for one employer who got hammered by IRS ($250K in fines) for some minor technical violations to the 401(K) plan. So always, always, always get a copy of the SPD and read it. At my last three employees (having learned from the mistake made by the previously mentioned employer) I always gotcurrent copies of all benefit plans, READ THEM, and then made sure that payroll (my group) was following the exact wording of the plan. In all three cases when I came in, they were not. In some cases I had to sit down with HR and go over every possible issue and make sure either payroll was altered to fit the rules or the rules were formally altered to something payroll could comply with. Never assume that your employer is in strict compliance with the SPD, because sometimes they are not.
     

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