Must a employee take their employer's health insurance?

General Questions
#1

My wife and I were just married a couple of weeks ago, and we’re now trying to get finances, insurance, and such in order. I work for the state of TN and she works for a private PR firm where she and one other are the only full time employees (there are a couple of other part timers). I want to add her to my health insurance plan as it would be a much better deal and better coverage than her keeping the group insurance she currently has under her employer. My wife asked her employer today what she needed to do to cancel her insurance so she can go under mine. Her boss told her that if she does not use the group insurance policy, then she will have to quit her job.

In the state of Tennessee, or anywhere for that matter, is this a legal practice? Isn’t it just common that husbands and wives very often use the insuance policy that benefits them greater, whether it be his or hers? My wife prefers not to quit, but her boss has been impossible to deal with for over a year now and a new job in the future wasn’t going to be out of the question, but we weren’t expecting to be forced like this. And then we have a time schedule. We were married June 10 and have 60 days to change my poilcy to add her. The next open enrolement is October. As far as I can tell those would be our only chances to add her to my policy, unless her losing her job counts as some sort of life-changing event that might cause an allowance to add her then, but I don’t know if that’s the case.

Anyway, does she have to actually keep her employer’s insurance?

#2

I work in HR systems consulting representing the internal benefits workings of dozens of large companies and millions of people. That is one of the stupidest things I have ever heard unless I am missing something big. Lots of people are in the situation you describe and it is never a problem. I am myself as a matter of fact. Companies usually pay the bulk of health insurance premiums and are happy when someone declines it.

#3

I read the details again and I think I might see some subtleties that would make it make more sense. The only possible way I could see her company wanting to do that is so that they can maintain their group health eligibility with their carrier. There might be a strict minimum for number of employees enrolled or minimum number of full-time employees and everyone could lose coverage or the rate could go way up.

If that isn’t it, it still makes no sense.

In case you think of having her double-covered, that makes a big mess and insurance carriers despise it if they don’t just disqualify someone for it.

#4

According to the previous accountant at the firm, there needed to be two people covered to maintain the group plan: the employer and one other employee. Currently there are two employees and the employer being covered. Granted we’re not supposed to know this detail, but we do.

Yes, double coverage doesn’t seem to make any sense except for the fact that dental is covered under my plan and not under hers.

#5

You need to check your company’s rules on this. Many companies have what they call is a “working spouse premium”, which is like a penalty you pay if your spouse is eligible for their own insurance but declines it in favor of the better policy.

If there weren’t some sort of penalty, it would make it easier for smaller companies to minimize their insurance plan and boost their wages, thus competing with larger companies for qualified applicants. The bigger company doesn’t see why it should help smaller companies compete with them.

#6

Years ago, I worked for a school district that maintained a self-insurance fund. All employees were required to participate. This was important so that the school could have as large a pool as possible. I had to pay $50 a month, even if I didn’t want the insurance. (I did want and I had the insurance, however.)

Maybe your wife’s company has similar rules.

Losing one’s job should certainly qualify as a life-changing event allowing you to enroll your wife in your company’s insurance plan. Check your company’s rules about having more than one health policy in force.

#7

IAN in the US, but this sounds like bunkem to me. Get your wife to ask her boss to show her where this is stated in her employment contract.

#8

People generally don’t have employment contracts in the U.S. unless you are in a union or some other exceptional circumstances. Most states have employment “at will” which means that the employee can quit at any time for any reason or no reason but the employers get the same privilege with your employment. It generally works out pretty well in practice but you can get the odd circumstance like here where someones job is threatened for some bizarre, completely illogical thing. Medical insurance has many state and federal laws associated with it but I don’t know of one that gives someone the right to opt out of a forced plan (IANAL however).