Health Insurance while on Work Comp

cindyp · September 2005

We have an EE who signed up for health insurance that was to become effective 9-4-05. However, on 8-4-05 he hurt his back resulting in a W/C claim. He worked light duty for a short time and then the Dr gave him total restriction from work 8-24-05 through his 9-12-05 recheck. Do I have to begin his insurance on 9-4-05? Our policy is that employees must maintain 30 hours per week to be eligible and he is at 0, but since it is w/c can I hold off his enrollment date until he returns to 30 hours per week? Our policy also states that if an employee who alredy has coverage falls below 30 hours they pay a higher rate for the insurance. If I do enroll him can I charge him the higher rate? Thanks for your help.

Whatever · September 2005

Many (not all) policies have a clause about being at work when insurance becomes effective. Check your policy.

POPEYE · September 2005

Whatever is absolutely correct. Our policy states than an EE must be "actively" at work to enroll. Not on any type leave.

LivindonSouth · September 2005

Also be acutely aware of your state comp laws. Some states prohibit certain personnel actions when someone is out on comp.

Unless your policy specifically says one must be an active ee to be enrolled, I would go ahead and enroll. Why not do that?

cindyp · September 2005

Our policy does say that they must be active. If I enroll himwhen he is not working, we pay the premiums and he has no check from which to deduct premiums. I will call the state to be sure there isn't some legal problem there. Thanks.

Whatever · September 2005

Even with a long term ee who is out on wc, you would still not have a check from which to deduct premiums.

irenesmsaclaims · September 2005

Be a little careful with this one. Actively-at-work clauses which delay or deny coverage based on a health condition are a violation of HIPAA.

pork1 · September 2005

CINDYP: That is where the adjustment and higher premium pay comes in. If there is no wage to deduct the insurance premium from, your company pays it and when the individual is returned to duty, be it light duty or regular full time duty, you figure what the company has paid on the ee's behalf and then figure out what the ee owes for the premium paid and adjust that individuals premium in order to get back to the appropriate premium paid by everyone else.

If someone was in a W/C situation in our company that person would be entitled to enroll their person and family members into our plan. Other factors on being out for "any days" would most likely have disqualified the individual from a working situation with our company, thus the issue of entitlement to company sponsored insurance would not arise.

I hope this helps or maybe I am the one confused.

PORK

Health Insurance while on Work Comp

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