Can some cafeteria plan participants be forced to buy school health in

[Guest Dale Hinckley]

Can a school with a cafeteria benefits plan require some employees to purchase (expensive) health insurance through the school, while others (covered by spouses' health insurance) can opt out, or must it let all employees choose where to get their health insurance?

[KIP KRAUS]

Dale:

In most opt out plans I’ve been involved in if an employee can provide evidence that he/she has group medical coverage elsewhere (through a spouses’ employer for instance), then the company pays these employees an opt out payment, which is regular income and taxable.

The employer does not force the employee to purchase coverage, it merely allows them to receive the opt out payments if coverage is provided elsewhere.

The chances of an employee purchasing coverage on an individual basis at the level provided through an employer at a price any where near the employer’s price is slim and none, so in my opinion, it becomes a mute point as to how expensive the employer’s plan is.

On the other hand, if you choose to go without medical coverage, that's your prerogative.

[Guest Dale Hinckley]

Thanks, Kip. In fact, the plan offered by the school (an independent school) is inferior to and much more expensive than ordinary Blue Cross coverage. If employees are covered by their spouses' plans, they do not have to buy the insurance. We are given the impression that simply obtaining equivalent coverage outside (by buying an individual or family Blue Cross plan, for ex.) does not permit us to opt out of the school plan: the spouse (and family) must be covered by an employer plan. My question is specifically: is this legal? It seems to discriminate against single people and those with nonworking spouses, or spouses not covered by employer plans. I can get better coverage cheaper outside the plan. Can I be required to participate in the school plan?

[KIP KRAUS]

I don't know of any law that would require you to participate in the school's plan, but, in my opinion, they do not have to give you an opt-out payment if you do not meet the opt-out requirements.

What makes you say that the school's plan is inferior to a individual pay Blue Cross plan?