Your employer may offer health insurance as part of your benefits package. If so, you should receive information yearly on your options, the premiums for each choice, and what the insurance covers. Some people find, however, that the premiums are simply too high or the coverage does not meet their specific needs.
Do You Have to Enroll in Your Employer’s Health Insurance Plan?
In short, the answer is yes — if the employer chooses to make you do so. This depends on several factors and is based on logic that may seem a bit tortuous but actually makes sense.
Not every employer requires employees to have health insurance or to take advantage of employee benefit options. Your human resources department or your manage should be able to answer your questions about requirements for employee healthcare and other benefits.
Why Do Some Employers Make Group Health Insurance Mandatory?
Employers have several reasons for requiring employees to accept healthcare coverage. Employers know that if you have no insurance, you are likely to suffer tremendous financial issues if you get sick. Nothing is cheap in the medical world; a simple doctor’s visit can cost you more than $100. By offering health insurance, employers make sure that you have coverage in case you get sick so that you can get back to work quickly and meet your healthcare cost obligations. This makes you a better employee because you are not suddenly faced with healthcare issues that you cannot afford to solve.
Further, employers know that those without health insurance wind up costing everyone more money. This is because insurance companies base their rates on how many people are in the group or pool of applicants. The more people from a company who take insurance, the cheaper everyone’s premiums are. Insurance companies base their rates on the risk they are taking; with more people, the risk of a large payout is spread over a greater number of people and, at least theoretically, reduced.
Finally, employers may require employees to purchase health insurance because they do not want to be liable for failure to cover their workers. According to the Affordable Care Act, employers are required to offer healthcare to their employees if they meet certain tests, such as number of workers and annual wages paid. Employers with more than 50 employees can face stiff fines if they do not offer healthcare coverage to their employees, and those with more than 200 employees have special rules that apply to them. Employers may feel it is better to make the enrollment in health care a requirement than to explain to tax authorities why some employees do not have coverage.
What If I Already Have Health Insurance Coverage?
In most cases, if you are already covered by a spouse’s or parent’s health care insurance, you are not required to take the employer’s plan. In those cases, you simply submit a statement to your employer showing the terms of your coverage. While there is no law that prevents the employer from forcing you to accept its coverage, most employers never insist on this if you show proof you are already insured. In fact, if you are already insured through another plan, that insurance company will ask about any other coverage you have and may subrogate claims made by you to your primary insurer. This means that your other insurance might not pay your bills and force you to use the other insurance coverage. In such cases, it is best to speak with the human resources department about your dilemma.
Sometimes employees have the opposite problem—the coverage offered by their own employer is more affordable than the coverage offered by their spouse’s or parent’s job. In these cases, many employers allow the couple to choose between the cheaper or better of the two insurance policies.
Can Employers Refuse a Request to Drop or Opt Out of Coverage?
There are times when you simply do not want to accept an employer’s insurance coverage. However, if the employer continues to take the premiums out of your paycheck there is little you can do to combat this without the employer’s agreement. First, talk to your human resources department. It may be that there is a waiver available but not widely advertised. Human resources may also be able to point you in the right direction of people who can make the decision to allow a waiver in your case. If this has no effect, you really should consult with an attorney or you may be stuck with health insurance you do not really want (or need).
