Can employer compel employee to get health ins through spouse if available?

collegestreet

With regard to an employer "offering" heath insurance benefits, can an employer require its employees to obtain heath insurance from a spouse's plan (if available through the spouse's employer) or from any other source (medicare, military etc.) if available ... such that its plan is only available to those employees that attest they cannot obtain health insurance though any other source? That is, can an employer require its own employees to attest that they cannot get coverage through their spouse's employer or other sources before providing them with health insurance under its plan? (I have seen various policies where an employer's plan requires its employee's spouses to obtain insurance from other sources if available; but this issue is a little different as it relates to requiring the employee to do so.) I would greatly appreciate thoughts on this and direction to any specific authority for my own continued research and reliance.

sonny

This is has come up before and I don't have a for sure answer to your specific question however we are still looking for a DEFINITIVE answer as to our ability to offer an incentive to NOT take our insurance. Right now, we cover all employees whether they want it or not. We do have ee's with Tricare or who are covered by spouses who would love a couple extra vacation days or a thousand bucks to opt out. I know offering incentives has become frowned upon but don't know if you CAN'T do it.

joannie

I'm pretty certain you can not force employees to use Medicare, but don't know about spousal or other coverage.

sonny

Agree on the Medicare. . .I had actually added that as an edit but it got lost in cyber space.

chemker

There are a number of trona mines (a mineral ore that gets processed into soda ash for the production of glass and detergents) just west of town, and their employees are required to access health insurance via their spouses' employers if available. It creats an undue hardship on our part-time folks, who are then forced to spend a sizable chunk of their earnings paying for the coverage. I would love to know how another company's policies can impact our own employees, but have so far just been assuming that it must be kosher just because it's happening. If anyone is able to get a definitive answer about this question, I would be eager to hear it.

Dutch2

I checked with our TPA regarding these questions and received the following information:
"An employer may not require an employee to take Medicare instead of the employer plan as this would be a violation of the Medicare Secondary Payer rules. Generally, all government programs pay secondary to the employer plan." and " As far as an employer plan that mandates their own employees go on a spouse plan before their own employer plan, that is completely foreign to me. I am not sure if you can make a stipulation like that as an employer plan about your own employees. I can get with our DC Consultant and find out."
"State Laws: Watch for state laws that limit spousal reduction provisions. There is case law indicating that spousal reduction provisions are considered a form of marital discrimination."
Plan Document Issue: "Employers must remember to furnish each participant with a description of a plan change in a timely manner. ERISA requires that plan participants be notified of a material reduction in covered services and benefits no later than 60 days after the date of adoption of the change."

sonny

Thanks Dutch. . .any comment on the incentive issue? It would be voluntary, not mandatory.