Flyboyjohn Posted September 16, 2014 Share Posted September 16, 2014 This doesn't pass any smell test but I can't find the legal prohibition: Large group health plan has terrible claims history based on 1 particular employee Insurer telling employer "If we don't have to cover the sick employee your group renewal rate increase is only X% but if the sick employee coverage continues the group rate increases by 3X%" Employer obviously wants to exclude the sick employee from coverage (and raise his wages by enough to cover his premiums for Marketplace coverage where his pre-existing conditions don't matter). This has to violate somethng? Link to comment Share on other sites More sharing options...
GBurns Posted September 16, 2014 Share Posted September 16, 2014 I suggest that you look at: 1. Your state health insurance law. 2. ERISA especially section 510. 3. FLSA especially section 18C if the employee gets a subsidy by taking the Marketplace coverage. 4. ADA 5. EEOC. In short, you will have a major problem because you are interfering with the employee's right to participate in the plan/receive benefits and you are discriminating against the employee for a sickness etc. George D. Burns Cost Reduction Strategies Burns and Associates, Inc www.costreductionstrategies.com(under construction) www.employeebenefitsstrategies.com(under construction) Link to comment Share on other sites More sharing options...
lvena Posted September 17, 2014 Share Posted September 17, 2014 I have seen this done in the past, but with a slightly different twist. Group had a self-funded plan and a fully-insured HMO plan. If a person in the self-funded plan exceeded a certain threshold of claim cost they were forced onto the HMO. So my gut tells me that it may still be possible, but cannot verify for you. Agree with G Burns, there are so many laws that come into play that this could easily blow-up in the employer face. If they are even slightly considering doing this, they should seek out legal advice. Link to comment Share on other sites More sharing options...
rcline46 Posted September 17, 2014 Share Posted September 17, 2014 Just for fun, get the person who is suggesting that strategy from the insurance company to put the recommendation in writing and countersigned by his/her manager. Link to comment Share on other sites More sharing options...
KED Posted September 17, 2014 Share Posted September 17, 2014 HIPAA nondiscrimination rules Link to comment Share on other sites More sharing options...
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