Telephone:

(877) 287-4325

(866) 619-0128 (fax)

Can my employer require that I join the company's health plan as a condition of my employment?

If your employer pays part or all of your health insurance premium, it can require you to participate in the health plan. There is no law that prohibits an employer from doing so.

This requirement may seem unfair, but consider other conditions employers routinely dictate to their employees, including job-related travel, adherence to dress codes, and participation in employer-sponsored workshops or classes.

Employers may demand employee participation in the company's health plan because in some states the insurer can impose "minimum participation" requirements. The insurer may stipulate, for example, that 85 percent of the company's employees must belong to the health plan in order for the insurer to cover the group. This is to make certain that the plan participants represent a mix of healthy and unhealthy employees.

What is the difference between Traditional, PPO and HMO coverage?

The level of benefits (i.e., generosity of coverage, deductible and co pays), and the amount of freedom to choose among physicians and hospitals are usually the two main differences. See below . . .

Traditional: There are no lists of physicians and hospitals. You may use any Doctor you want to, and the plan will pay the bill (subject to UCR clauses). Some plans consider a physician as a "licensed practitioner of the healing arts, which practices within the scope of their license". This lets you use Naturopathic and Chiropractic practitioners.

PPO: A Preferred Provider Organization is a network of physicians and hospitals that have agreed, by contract, to discount their rates to members. The networks are typically very large, and the members are free to seek care from any physician or provider within the network, including specialists without a referral. Members may also access non-contracted providers, but at a higher out-of-pocket cost. If you were to buy a PPO plan instead of a Traditional plan, you would never know the difference as long as you used the provider list. Typically PPO plans might offer some front-end co-payments for such services as doctor visits and prescriptions. Most other covered services (i.e., inpatient hospital services and surgeries) are typically subject to a calendar year deductible and/or coinsurance (where applicable).

HMO: A Health Maintenance Organization provides benefits for preventive care coverage and low out-of-pocket costs. There is typically no coverage for care from doctors or hospitals outside your HMO. Plans usually offer comprehensive benefits and affordable premiums with no deductibles. You choose a Primary Care Physician from a network; This Doctor oversees all your care, and may provide referrals to specialist if needed.