I am representive of a small number of employee, employed by a mid size firm located in West Virginia, with corporate headquarters located in San Antonio, Texas. Our problem lies with health care benefits and wages. The package offered to the San Antonio employees of the same firm is substantially better than the level of benefits available to the WV employees. In the health care insurance benefit arena - our out of pocket expenses are greater, co-pays for office visits and prescriptions higher, and the level of paid benefits is far below those available to our Texas co-workers. Wages paid employees for the employment at same grade, same position in our area is significantly lower for West Virginia employees. All this in an area which has a higher consumer cost of living index.
The Texas employees are covered under an HMO (QPAS) plan which is not available to the West Virginia employees. The insurance carrier does not have a HMO "network" available in our area, so our health coverage is provided by the same carrier under a Preferred Provider (PPO) plan. The selection of PPO providers in our area is very limited, many "speciality services" are not even available (although there are practioners in the area-they do not particpate with the plan coverage) and even with an "approved PPO provider", our employees are financially responsible for a higher co-pay on services and the insurance company only pays 90%, after the deductible (a deductible, which by the way our Texas co-workers do not have under their plan).
We have experienced more than a few problems with the coverage of payable benefits and have requested our employer provide a copy of the policy , all we have is a "Summary of Benefits", which is totally inadequate in determining coverage for services.
I understand from the office of the West Virginia state Insurance Commissioner that all "PPO" plans are basically an "employer self-insured" plan and that the benefit level paid is determined by our company rather than the insurance carrier. Does this "employer self-insured" designation imply that the plan would fall under ERISA guidelines ? Does an "employer self-insured" plan mean that the insurance company will pay claims at the level directed by our employer ?
We know this is an "unfair", "inequitable", etc. situation, even our employer verbally "admits" this, but is it a "legal" situation ?All we have is an admission of unfairness along with a promise that when we have "more" employees the situation will be remedied. It's been two years, the project has been delayed and were looking at another 18 months before we have "more employees" and frankly, we're tired of waiting. The medical expenses are mounting for two of our employees who have had to the misfortune to use the insurance coverage and we can't help thinking how much better off we would be if we were employed/working in San Antonio. Since we are all employees of the same company, abeit working at different locations, is our employer legal bound by any state or federal law to offer the same level of benefits and rate of pay to all it's employees ?
Thanks,
C
The Texas employees are covered under an HMO (QPAS) plan which is not available to the West Virginia employees. The insurance carrier does not have a HMO "network" available in our area, so our health coverage is provided by the same carrier under a Preferred Provider (PPO) plan. The selection of PPO providers in our area is very limited, many "speciality services" are not even available (although there are practioners in the area-they do not particpate with the plan coverage) and even with an "approved PPO provider", our employees are financially responsible for a higher co-pay on services and the insurance company only pays 90%, after the deductible (a deductible, which by the way our Texas co-workers do not have under their plan).
We have experienced more than a few problems with the coverage of payable benefits and have requested our employer provide a copy of the policy , all we have is a "Summary of Benefits", which is totally inadequate in determining coverage for services.
I understand from the office of the West Virginia state Insurance Commissioner that all "PPO" plans are basically an "employer self-insured" plan and that the benefit level paid is determined by our company rather than the insurance carrier. Does this "employer self-insured" designation imply that the plan would fall under ERISA guidelines ? Does an "employer self-insured" plan mean that the insurance company will pay claims at the level directed by our employer ?
We know this is an "unfair", "inequitable", etc. situation, even our employer verbally "admits" this, but is it a "legal" situation ?All we have is an admission of unfairness along with a promise that when we have "more" employees the situation will be remedied. It's been two years, the project has been delayed and were looking at another 18 months before we have "more employees" and frankly, we're tired of waiting. The medical expenses are mounting for two of our employees who have had to the misfortune to use the insurance coverage and we can't help thinking how much better off we would be if we were employed/working in San Antonio. Since we are all employees of the same company, abeit working at different locations, is our employer legal bound by any state or federal law to offer the same level of benefits and rate of pay to all it's employees ?
Thanks,
C
