Ask ee to sign health insurance waiver

T

I have an ee who is a high risk to our health insurance company. When we were quoted our rate, I was told the reason it was so high was due to one ee.

So, we did not take this insurance. Instead we renewed our old policy because they don't do medical certification. Well, that renewal went up also and this one ee along with 18 others chose to waive it and not be insured.

Is it ok to ask her to sign a waiver with the first insurance company so the rates will go down and the other 18 people who waived due to the increase can now afford it?

Thanks.
-t

smaces_twin

NO. You would be discriminating against someone because of a health condition. You can't "force" someone off the plan to keep your rates down.

NancyJ

Yikes - no! You shouldn't even know this information.

irenesmsaclaims

I'm a little confused. The one employee who is causing the high rates is voluntarily waiving coverage? If a person waives coverage, you should ALWAYS get a written waiver, so there are no problems with potential claims in the future. Health status is not relevent with written waivers. With all waivers, I would contact the agent and see if a quote can be obtained with the new census.

smaces_twin

So you would advise her to ask the unhealthy person to waive her insurance so the others can get it?

irenesmsaclaims

Never, I thought the original poster said that this employee chose to waive coverage.

T

When the quote came back from insurance-1. We were not able to go with that company. So we went back to who we were with, insurance-2, and their rates went up a little. When their rates went up the high risk employee waived coverage.

I was told by insurance-1 to ask her if she would sign a waiver with them to allow the rates to drop so we could sign on with insurance-1.

My gut feeling told me not to ask her so that's why I am checking with y'all. It doesn't seem fair to me, but why would the representative from insurance-1 tell me to ask her... for a sell of course!!!$$$$$

thanks.
-t

smaces_twin

I think the word chose is debatable. When presented with the fact that if they didn't waive coverage no one would get insurance, I think they could argue that they were forced. I wouldn't want to be presented with that scenario.

T

The thing with asking her to waive would prevent everyone else from dropping (17 other employees). Which then makes us not in compliance with the eligibility requirements of the insurance company. Bottom line is the company as a whole will be dropped because of lack of participation.

However, I am still on the lookout for a less expensive insurance-impossible????

smaces_twin

If you asked her to drop her coverage so others can get it, it could very easily be construed as you forcing her. I would never do it and I would raise hell with the insurance person that advised you to do it. They made a serious error.

I was actually thinking about the follow up question you just asked yesterday. At times I'm sure it seems you have a problem that can't be solved. Some would categorize it as a crisis. Small employers are getting killed because they can't get the strength in numbers that others can. Fully insured products are going to be able to spread your risk, but they continue to charge you as if they are not. In this area, we have a PPO organization that is actually trying to create a small business product where the insurer is going to discount premiums to a pool of small businesses. The providers and hospital are going to give deep discounts to this product, but they will enforce a cap on the profits of the insurer. Everyone wins with this model. Small businesses get a more affordable product, providers and hospital will get paid for their services (even though it's discounted, it's better than writing it off as bad debt when they don't get paid), and the insurer gets more revenue with some profit. If you have contacts in the business I would float this idea. Be aware that it will have to pass your state insurance regulators. And large insurers will fight this. However, we are moving forward and we found a medium size insurer that is willing to take the risk. The big guys will not touch it with a ten foot pole.

Don D

smace - Maybe I'm just dense, but I've seen T say three times that she was not asked to waive, she dropped her coverage. There is no information given that would have us believe the company suggested that to her. How do you continue to arrive at that conclusion? Or did I miss it? x:-)

smaces_twin

[font size="1" color="#FF0000"]LAST EDITED ON 07-09-04 AT 03:57PM (CST)[/font][br][br]I reviewed the posts and I didn't see what you were talking about. T asked:

"I was told by insurance-1 to ask her if she would sign a waiver with them to allow the rates to drop so we could sign on with insurance-1.

My gut feeling told me not to ask her so that's why I am checking with y'all. It doesn't seem fair to me, but why would the representative from insurance-1 tell me to ask her... "

She also said:

"The thing with asking her to waive would prevent everyone else from dropping (17 other employees). "

Her first post said:

"Is it ok to ask her to sign a waiver with the first insurance company so the rates will go down and the other 18 people who waived due to the increase can now afford it?"


They all waived insurance because they couldn't afford it. The reason they couldn't afford it is because the "time bomb" was going to be covered. What her agent suggested was to get the "time bomb" to drop his/her coverage so everyone else could get it. As I said before that would be a slippery slope. If I've got it wrong, show me.


Are you pulling a Ritaanz on me or am I crazy?

lnelson

Anytime an ee voluntarily waives their insurance I have them sign a waiver refused coverage. Sometimes ee will state reason sometimes not. I usually ask to see if we can do anything.

If the rates were the same the ee would continue insurance coverage and so would the other 18 ees. But due to the one ee the rates went up and now 18 others do not want it also.

Find another carrier or change the plan to lower the increase.

Sounds to me if you ask for waiver from this one ee then the rates are lowered so that everyone else has coverage you are forcing the ee to do it to keep cost down.

What happens when ee finds out what the rates are and they will?

JMO,
Lisa