Employer inceasing health premium 50% after enrollment period is closed? can they do

[lynn_s]

Putting this here since this is going to put a serious crimp in my "next Disney trip" budget.

Question one is, can they do this.
Question two - I must be googling the wrong terms since I cant find the answer to #1 - where do I need to look?

More details. Back in the fall, during DH's "annual election" period, we received the usual packet with, we are going with this company for health care this year, here are the monthly costs, here's what it covers etc. Health Coverage was listed as X per month for family. This was a better deal than my company offers, so we went with that.

Got a letter today that says those rates are "special discounted rates only if employee and spouse are compliant" with their health screening requirements by 3/31. otherwise its going to cost approx 1.5 times what we were told originally per month. "Compliant" includes a health questionnaire (with ridiculous questions on it) and either a dr.s physical between 1/1/2011 and 3/31.2011 or their on-site screening (available this morning, and next Tuesday/Wednesday). I can't take off work with that little notice due to out of office projects.

So, I find it hard to believe they can change things that much with that little notice. I would not have had a problem with a required physical or screening for lower rates, if it was disclosed at the time we signed up. Its the after the fact bait and switch that bothers me.

I am trying to find what if any laws/regulations might apply before I raise a stink about it, and was hoping someone on here could point me in the right direction.

 

[My3kiddos]

Putting this here since this is going to put a serious crimp in my "next Disney trip" budget.

Question one is, can they do this.
Question two - I must be googling the wrong terms since I cant find the answer to #1 - where do I need to look?

More details. Back in the fall, during DH's "annual election" period, we received the usual packet with, we are going with this company for health care this year, here are the monthly costs, here's what it covers etc. Health Coverage was listed as X per month for family. This was a better deal than my company offers, so we went with that.

Got a letter today that says those rates are "special discounted rates only if employee and spouse are compliant" with their health screening requirements by 3/31. otherwise its going to cost approx 1.5 times what we were told originally per month. "Compliant" includes a health questionnaire (with ridiculous questions on it) and either a dr.s physical between 1/1/2011 and 3/31.2011 or their on-site screening (available this morning, and next Tuesday/Wednesday). I can't take off work with that little notice due to out of office projects.

So, I find it hard to believe they can change things that much with that little notice. I would not have had a problem with a required physical or screening for lower rates, if it was disclosed at the time we signed up. Its the after the fact bait and switch that bothers me.

I am trying to find what if any laws/regulations might apply before I raise a stink about it, and was hoping someone on here could point me in the right direction.

WOW!
Here you go! From http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html#NonDiscrimination

Can a group health plan require me to pass a physical examination before I am eligible to enroll?
No. You do not have to pass a physical exam to be eligible for enrollment. This is true for individuals who enroll when first eligible, as well as for late and special enrollees.


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Can my plan require me to take a physical exam or fill out a health care questionnaire in order to enroll?
Yes, as long as it does not use individual health information to restrict enrollment or charge you more.


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My group health plan required me to complete a detailed health history questionnaire and then subtracted “health points” for prior or current health conditions. To enroll in the plan, an employee had to score 70 out of 100 total points. I scored only 50 and was denied a chance to enroll. Can the plan do this?
No. In this case the plan used health information to exclude you from enrolling in the plan. This practice is discriminatory, and it is prohibited.

They can have you do a physical exam and fill out a health questionnaire but they can not charge you more for the answers they receive. I'm not sure if it's legal to charge you more for refusing to do it though. I would tell them I can't take off work to do it and they will need to pay for me to have an exam after hours.

 

[My3kiddos]

Sorry this may be your answer. Who gets the test results? Your work or your insurer? I know at work we personally can't ask health questions. I think it's crap though. Sounds like a way for the company to not pay out as much in benefits because alot of people won't want to do that.

I belong to a group health plan that rewards individuals who volunteer to be tested for early detection of health problems, such as high cholesterol. Can a plan do this?
Yes, as long as the health plan offers the reward based on participation in the program and not on test results. For instance, a health plan might offer a premium discount for those who voluntarily test for cholesterol. The discount would be available to everyone who takes the test, not just those who get a certain result.

 

[Smile&Nod]

Sorry this may be your answer. Who gets the test results? Your work or your insurer? I know at work we personally can't ask health questions. I think it's crap though. Sounds like a way for the company to not pay out as much in benefits because alot of people won't want to do that.

I belong to a group health plan that rewards individuals who volunteer to be tested for early detection of health problems, such as high cholesterol. Can a plan do this?
Yes, as long as the health plan offers the reward based on participation in the program and not on test results. For instance, a health plan might offer a premium discount for those who voluntarily test for cholesterol. The discount would be available to everyone who takes the test, not just those who get a certain result.

Agreed - an employer can offer an incentive to people who fill out health risk assessments or take part in screening but they cannot penalize those who don't - so should they have said, the premiums are 1.5X and if you do this we'll take them down to X instead of the way they said it, yes, but the end result is the same.

 

[gigi1976]

From my experience as an HR Generalist, at the company I worked for there was plan A with better benefits and plan B with worse, they both had the same premium, but in order to get A you had to jump through hoops like questionaires, providing BP, cholesterol, and other screening numbers to the insurance company. It was my understanding that they had the same premium as it was none of the companies business who was jumping through the hoops and who wasn't (hipaa). We didn't know who had the richer plan until they came with a coverage question and would show us their card. I'm not sure how relevant my experience is compared to yours, but just thought I'd throw that out.

 

[ZellyB]

I believe that, yes, they can do this. They aren't saying they will not cover you, just charge you more, right? So, as far as I know, they are legally entitled to do so.

It's not dissimilar to charging higher rates to tobacco users. Something my employer does.

 

[Cindy B]

My DH works for one of the major health care insurers. (he's been there for over ten years). In the past four or five years, the employer REQUIRED all employees to complete a health screening questionare or no insurance.. no questions asked.

When you do your enrollment package, this stipulation is all over the material so yes, it can be done. The health screening questionarre does not go over to HR, but goes to a different place.

It isn't a big deal, just anser the questions in any way you want.

 

[lynn_s]

Thanks all - I knew plans could offer incentives for various wellness programs

My problem is that the rate we were initially told was not presented as a discount rate - only one rate was listed, no mention at all of requirements for screenings etc. There was no mention on the enrollment material of two different rates, questionnaires etc.

They are now saying the rate we were given at sign up time is a discounted/incentive rate, and the regular rate is much higher (The first time we saw the regular rates on paper was today). If I'd have know this back when we signed up, I'd have had plenty of time to see my regular Dr. Physicals there are usually 6+weeks out.

So just to clarify, my main issue is the difference in rates was not disclosed during the enrollment period. And aren't giving much time to get in compliance with all their hoops.

 

[living la vida mickey]

This is sometimes called a wellness incentive. It's a way to get people screened so that if there are health risks, they can be addressed early on and in the end cost your insurance plan less money. Going through the screening allows you the incentive of less premium than refusing to do it.

 

[peggster]

Thanks all - I knew plans could offer incentives for various wellness programs

My problem is that the rate we were initially told was not presented as a discount rate - only one rate was listed, no mention at all of requirements for screenings etc. There was no mention on the enrollment material of two different rates, questionnaires etc.

They are now saying the rate we were given at sign up time is a discounted/incentive rate, and the regular rate is much higher (The first time we saw the regular rates on paper was today). If I'd have know this back when we signed up, I'd have had plenty of time to see my regular Dr. Physicals there are usually 6+weeks out.

So just to clarify, my main issue is the difference in rates was not disclosed during the enrollment period. And aren't giving much time to get in compliance with all their hoops.

I guess the question at this point is: are you willing to jump through the hoops? If so and the biggest issue is the short notice (which I agree is nuts), you might want to try talking to HR about that to see if an extension is possible. If you're not willing to jump through hoops or if they won't grant you an extension on the deadline, then you'd need to find out if this is something they can do after open enrollment. I would hope that they can't, because at least in my experience, once open enrollment is over you can't make changes to your health insurance plan, so they'd be forcing you to pay higher rates without a chance to choose another option.

 

[3boymthr]

It sounds as though your company isn't following the rules but I did have a thought about the fact that they may be doing this because of a retroactie rate change (and yes this can happen). There are several reasons this can happen. Most of them would not involve having employees do what is being requested. However; there are some health carriers which make their rates contingent upon a health questionnaire or health screening. If an employee does not participate in the health screening/questionnaire the rates go up. It's written into the contract that the company signs. This is mostly a product offered to companies which are considered "small" businesses so less than 50 employees. The rates that initially quoted are generally an incentive rate that is lower based upon the assumption that all employees are healthy with the proviso that the data must be provided or the rates will be raised by x percent. Not all companies read the fine print or it's not always disclosed clearly by the broker and then the company gets a "surprise" notice that says we need this by x date or the rates are going up. If this applies to your company this may be what's happening to you.

 

[tlbwriter]

Call your state's insurance board and ask if your employer is allowed to institute a retroactive rate hike.

 

[Arielle22]

Your insurance is through your DH. Is it possible he was given the information at open enrollment but did not convey it to you?

Any questions for HR should go through him, not you. HR has no obligation to speak with you since you are not the employee.

The link by My3kiddos refers to discrimination in enrollment. Your issue refers to premiums which is not mentioned.

Are your premiums withheld pre-tax or post-tax?