Insurance Eligiblity
debboyer
22 Posts
I would really appreciate some help with this issue! I have an employee who has a habit of missing a minimum of 1 day per week. Instead of disciplining for behavior the President of the company has opted to change the benefit package so that all employees must work 35 hours a week to qualify for insurance.
She has now used all available free time and every day missed will put her at risk of losing her benefits. I have discussed this with her openly but she is of the mind thought that she has slipped by all these years (12 years) with the same pattern of working when she wants that nothing will happen.
How do you determine when you can make her ineligible for benefits? And if you make her ineligible is her next eligibility at open enrollment. This is a mess! She has been written up several times, she should be terminated as the write-ups have no effect but when the top management refuses to terminate and make these restrictions I need some real input in how to implement what he has requested.
Frustrated.... and in need of ideas and suggestions!
She has now used all available free time and every day missed will put her at risk of losing her benefits. I have discussed this with her openly but she is of the mind thought that she has slipped by all these years (12 years) with the same pattern of working when she wants that nothing will happen.
How do you determine when you can make her ineligible for benefits? And if you make her ineligible is her next eligibility at open enrollment. This is a mess! She has been written up several times, she should be terminated as the write-ups have no effect but when the top management refuses to terminate and make these restrictions I need some real input in how to implement what he has requested.
Frustrated.... and in need of ideas and suggestions!
Comments
It doesn't sound like all the pieces have been put into place, or this employee would be paying attention (unless she doesn't care if she loses her benefits).
All the questions you asked should be answered, put into writing, and communicated to the employees clearly before you even think about taking any benefit action against this employee.
First, get an effective date. It can't be retro. You might consider starting it at the next benefit period (ie January 1st if that is your plan year). Next, determine if you will allow employees who lose their benefits back on when open enrollment comes around. Will you kick them off the plan again if the behavior re-occurs?
Ask your President what he/she will do when this employee comes crying because they have no health coverage and something has happened? Or even if the employee comes crying because they just lost the benefit?
Also, your President should consider the administrative nightmare of enrolling, terminating, and re-enrolling employees for benefits, especially as a way to discipline for behavior issues. And even more critical, is this employee in a protected class? What will your company look like in court if this employee is continually singled out and having her benefits cut off?
Your best bet is to look at all the possible consequences and explain them to the President. Very often upper management is unaware of all the ramifications of some decisions, and it is your job to bring the facts to their attention. When you do so, offer another solution. Changing the benefits has an impact on all employees, even the good ones. If the President doesn't want to term a long time employee, their are other solutions. She could be suspended without pay for instance. Think creatively and look at all the possible outcomes and options. Bring the facts to your President and offer at least one other solution. That's all you can do. If he/she still wants to move forward, make sure they agree to all the guidelines with full knowledge (the cost of adding and dropping employees, etc). Then you will know what to do, and also know that you have done your best for your company.
Let us know how it turns out. Good luck!
Nae
We are a small company and honestly probably one of the BEST businesses to work for. It is a privately owned business the employees are only responsible for 15% of the premium on Health Insurance and they pay nothing for Dental, Vision or Life for themselves or their family. We take vacations paid for by our company.
I am sharing this information to emphasize the point that they are above average at being fair, they understand the economy and they do not like to terminate or make public issues that go on so they feel canceling her insurance is their way to get her attention, she simply does not think they will go thorugh with it!
To them the cost of adding and deleting employees is small, we have virtually no turn over ratio as why would you want to leave when they are fair and generous about what they offer, however, I guess I just need to know if someone else has ever had to cancel insurance when an employee fails to work the required hours to maintain insurance. Their thought is they do not care if meeting the hours is using vacation time and that is not a penalty it is when you are not meeting the hours and are not using an approved LOA or vacation time.
I would terminate her coverage the same as if she left her employment (immediately or at the end of the month...however it currently works). Give her a letter reminding her of the current policy and why she is losing coverage. Then tell her when she will be eligible again.
You said there were lots of discussions about this. Did any of them address reinstatement? Unless it is likely that your carrier agreed she can come back on when she is working her full schedule again, I would assume she will not be eligible again until open enrollment. I would treat her the same then as I would any other employee who originally elected not to receive coverage, but wants it now. After all, if she knew the policy and still abused her time off she elected to lose her coverage.
I sincerely hope this employee will not be able to bring up FMLA or ADAAA and sue you for taking her health coverage away. I also hope one time of losing her coverage will do it for her. It might have the opposite affect though (no harm done and she saved some money). Write her letter and then brace yourself for her response. I am rooting for you! Good luck!
Nae