HR or healthcare question, maybe legal question too?

Kerrin · September 2011

If a company pays 100% of the health insurance for:

the employee, employee+spouse, employee+child, and employee + family and offers that coverage universally, can they exclude certain individuals from receiving the benefits?

ex. Bob chooses employee+family coverage at $0 cost. Bob's wife is a stay at home mom.

Sally chooses employee+family coverage at $0 cost. However, Sally's husband could get insurance through his employer, although said employer doesn't pay 100% of the premium like Sally's company. Sally is told that the company will not pay for medical benefits for her husband b/c he is eligible for insurance elsewhere.

Anyone deal with this? Seems like discrimination to me. Basically in a nut shell, is that all costs will be covered except those spouses who are eligible for insurance somewhere else. Can they exclude individuals like this? Is it true that under the new healthcare reform act, if employers offer coverage to a certain class, don't they have to offer it to all employees in the class equally?

KT&John · September 2011

I am not sure about what is allowed in light of the new healthcare reform act, but I have not heard of what your are describing. My DH's insurance charges a "penalty" fee if you chose to cover a spouse on his plan when they have coverage available through their employer, but I have not heard of coverage being refused altogether.

Janimal · September 2011

Yes, they can do that.

Is it discrimination - sure. But discrimination isn't illegal.

Discrimination is only illegal if it is based on certain characteristics, like age, race, color, sex, religion, national origin. So unless they are saying "Only white people get all premiums paid" or something like that - it's ok.

Now - if it were to turn out that only the WOMEN in the company had their spouses excluded, because all the dudes there have SAH wives, then despite their rule not being illegally discriminatory, the IMPACT has affected one protected class of employees unevenly. Then that would change things. But that's the only way I can think of that what they are doing would be a legal issue.

Louise06 · September 2011

My old employer would not cover my DH since he had insurance available through his employer. Pretty sure it is legal.

Kerrin · September 2011

I'm also going to add that this scenerio currently only affects ONE person in the workplace. Not sure if that changes things.

Janimal · September 2011

Doesn't change things. Perfectly legal for them to do so. It might be unfair, but it's perfectly legal.

And, if they have less than 15 employees, even the illegal discrimination stuff would be ok too.

TobeaPurvis · September 2011

Unfortunately DH's conpany is like this too. If I get a job that makes me eligible for an insurance policy I can no longer be on his. He has REALLY good insurance so I really don't want to lose the coverage. I'm not sure that it matters that it only affects one person at your company because it is becoming a more common practice unfortunately and it would be hard to prove that it was anything else than a company trying to cut costs. It sucks!:(

Mrs. Theobald · October 2011

I just received something from my employer that said I would have to pay an extra $25 a pay period (every 2 weeks) if my spouse was eligible for insurance elsewhere. I work for a freaking health system that only allows you to really see their doctors. I think this will detrimentally to their "business". If I get on DH's insurance I will make sure not to use any of their doctors! I can't believe companies are doing this. It is ridiculous.