Privacy about Insurance

TanyaE

The president of my company wants me to find out how many employees that we have that have declined medical insurance coverage for their spouse and/or children because of exsisting coverage elseware and find out why they declined the coverage. Then he would like to know how much it would cost for these employees to get on their spouses medical coverage at their place of employment. I feel that it is none of our business why they declined coverage in the first place and I also feel that this could be dipping into the HIPPA Privacy Act laws. Is that correct? Need help and advise.

Thanks,
Frustrated in HR

scottorr

I don't think this would be a HIPAA issue. However, I'm not sure how you would go about gathering that kind of data without stepping on a few toes. I'm sure the president has a good reason for wanting the information. How do you know if someone is married or if they have children? With some you could figure it out but others that don't want to share that information how would you obtain it?

TanyaE

I know all the employess that we have here and the ones that are married or not married. His reason for the information is because he would like to offer the employees and X amount of money each month to go and get on their spouses insurance because he feels that it is costing the company too much money for health insurance. We pay 75% of dependant coverage and 100% of employee coverage. He feels that we are paying for employees that could be on their spouses insurance at a lesser cost than it cost us each month and/or that we are paying for some employees that are also on their spouses insurance. So in other words we are paying for employees that are not even using our insurance or that we could pay X amount of dollars to each month and it would still be cheaper for us.

System

I think you're talking about possibly offering a waiver benefit to those employees who decline coverage. This is somewhat common in companies nowadays precisely because it can encourage employees to enroll in their spouse's plan and receive a monetary benefit in their paycheck. At a previous employer, we required employees to show the reason why they were waiving coverage - in other words, they needed to show proof that they had coverage elsewhere.

Also agree with the other posters who said this does not fall under HIPAA, but could be difficult to do after-the-fact.

juju

[font size="1" color="#FF0000"]LAST EDITED ON 08-21-03 AT 12:32PM (CST)[/font][p]If you have a section 125 plan, your employees cannot just "go on" their spouses' coverage at the drop of a hat. They need a qualifying event, and your president wanting them off your company's plan would not cut it. Not sure if that's what he was leaning toward though. You could, however, set up some type of reimbursement plan for employees who choose to waive insurance and really play it up for your next open enrollment.

As another poster said, in our company we do request proof of medical coverage in order for an employee to waive benefits and get the reimbursement (about $10/pay) we offer.

And personally, whether or not it is a HIPAA violation, I think employees' insurance choices and the reasons behind them are none of my business. As long as they comply with our enrollment or waiver procedures I'm happy.

scottorr

I'm guessing you are a some what small company. We offer an "opt out" waiver. We pay the ees that choose this $750 a year. We have them sign that they certify they have other coverage. I understand his point but I don't think the end result is going to save him all that much money. If he is looking to lower health care costs maybe you could look into wellness programs to help decrease utilization. Just a thought.

mwild31

This is a great question - and I hope I can help. I'm in the middle of renewing our health insurance & selecting a new broker right now.

There is a form that our insurance broker/carrier requires our employees to complete - it's called a "Waiver of Benefits". On the form, it asks who is not enrolling (employee, spouse & child)& the reason for not electing benefits. You may want to ask your broker/carrier for this form - I never realized it was optional for a company not to have employees fill out one out - but maybe it's different for different insurance carriers. I have a copy of the form we use if you want to send me your email address.

As to providing a monetary benefit to employees who use their spouses/domestic partner plan, my only experience with this is to say 'no' to the employees who ask for it. My reasoning is that I'm in a precarious situation, I fluctuate between 98 to 110 employees throughout the year, and I get a price break on my quotes when I have everyone fully insured and 100% participation at 100 employees. When I compare the price break to other alternatives - it quickly becomes a wash. Also, it saves potential headaches later down the road, i.e. the employee's spouse lost their job & they don't have insurance any more, or maybe at the spouse's place of business the rates when sky high for dependents and now your employee wants to get back on your insurance. These are just some of my concerns with allowing employees to waive benefits - but they may not be everyone's.

Just my thoughts.......

Hunter1

Some of the information you need may be on your employees' health ins applications. Many of them ask about other insurance, dependents, other coverage, etc. Let me play devil's advocate for a minute: (Let's forget about section 125, waiting periods, open enrollment, difference in employee contribution, etc. for the moment.) So, all of us employers get into this bidding war with each other, trying to outdo the others' offers to get our employees on someone else's plan. Your employees' spouses' employers are doing the same thing. Who wins? The employee who has other coverage available. In a perfect world, we'd all cover our own risks; let's not try to pawn them off on someone else.