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Marc asked in Business & FinanceInsurance · 7 years ago

Can health insurance be declined during open enrollment?

We are in Texas. My wife's insurance through her employer is almost doubling next year (starting in October). They are currently in open enrollment. Her crappy HMO will cost as much as a gold-level private plan. The HR company that handles their benefits claims that she can't decline coverage during open enrollment unless she is enrolled in another plan. Is this true? Can you not decline coverage and opt to be uninsured? She wouldn't be eligible for a marketplace plan until January 1. It seems like she is being trapped into a lesser, more expensive policy by the employer.

Update:

FWIW, pricing is without government subsidy.

8 Answers

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  • 7 years ago

    Unless her employer is paying 100% of the cost, she CAN, legally, opt out of the coverage. In a right to work state, though, they can fire her, for any reason they want - even if that reason is, "because you didn't buy into our health insurance program." Why would they fire her over this? Because Obamacare will fine the employer, if they don't have a high enough percentage of employees enrolled in the plan.

  • Kini
    Lv 7
    7 years ago

    You can decline the employer insurance during open enrollment and pick up an Obamacare plan in November.

  • Zarnev
    Lv 7
    7 years ago

    That is probably correct. Depending on the size of the company and the insurance that they have the new regulations require a certain percentage of eligible employees be covered by the group policy, and since it is now the requirement that you have insurance they cannot let you go uninsured.

    She is being trapped, but not by the employer. This is one of the unintended consequences of the ACA.

    She doesn't need a marketplace plan. The only reason to use the marketplace is for the subsidy, and since she has access to a group policy through her employer she does not qualify for the subsidy. The plans on the marketplace are essentially the same as those off of the marketplace with 2 major exceptions: those on the marketplace generally have smaller doctor networks and cover fewer medications than those off of the marketplace.

    Source(s): Independent Ägent, ACA Certified Broker
  • 7 years ago

    She may be able to force the issue because of state laws that prohibit an employer from withholding health insurance premiums without the employee's consent. If she simply refuses to reenroll, then they may have to decide between allowing her to be employed without insurance or firing her.

    Either way, she is not allowed to opt to be uninsured, and will owe a substantial penalty to the federal government for deciding not to be insured.

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  • 7 years ago

    Unless they pay for it outright, they can't force her to be on their plan. Open enrollment is just that. You can add or drop coverage during that time. Most small employers are getting rid of group plans anyway. If they get rid of them, then the gov't subsidizes the cost. And, if the gov't subsidizes, then why should the employer? Most small employers then add additional benefits elsewhere...more pay, more supplemental coverage, etc...

  • ?
    Lv 7
    7 years ago

    Actually, this is pretty straight forward. They have to provide coverage and she can only opt out if she has an alternative in place. They would have to fire her if she simply refused to re-enroll.

    Thanks PPACA...

  • 6 years ago

    For fast insurrance quotes

  • 5 years ago
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