Do I have to take their health insurance?

Discussion in 'General Education' started by GGarcia, Aug 17, 2013.

  1. GGarcia

    GGarcia Rookie

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    Aug 17, 2013

    This is my first year teaching and I am teaching on a contract that is more than 50%, but less than 80%. I asked if I had to take their health insurance and they said yes, because if I didn't they would have to pay a penalty due to Obamacare. I know this may vary between districts. However, taking their insurance will cost me $400 more than my current health insurance and give me less coverage. So basically, a good portion of my paycheck will be towards their insurance.

    Just wondering if anyone knows if it is absolutely mandatory to take it.
     
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  3. Caesar753

    Caesar753 Multitudinous

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    Will you have other coverage if you decline this coverage?
     
  4. GGarcia

    GGarcia Rookie

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    Yes, I have a good plan that I have been using for the past few years while I was a sub. I'm just confused, because the district said I have to take it, but that doesn't seem fair.

    edit-I am not married, so it is an individual plan.
     
  5. Caesar753

    Caesar753 Multitudinous

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    I can't imagine that they'd be able to require you to carry secondary coverage.

    I think you might need to ask some more questions and be ready to prove that you have other coverage.
     
  6. Pashtun

    Pashtun Fanatic

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    Welcome to the teaching workforce. We just got out of a housing collapse, next up;...health care collapse. I give it 10 years.
     
  7. kpa1b2

    kpa1b2 Aficionado

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    It seems to me that I had to provide proof that I was covered under my husband's plan. A slightly less expensive plan with better coverage where we needed it.
     
  8. GGarcia

    GGarcia Rookie

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    I asked her 3 times during my meeting and she said yes, because the district would have to pay a fine. However, I had a weird feeling during the meeting since she was also pushing me to take additional benefits (life, disability) that I was not interested in. I don't know who else to ask, which is why I am trying to find out more.
     
  9. Caesar753

    Caesar753 Multitudinous

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    Did you specifically tell her that you have other coverage?
     
  10. dave1mo

    dave1mo Comrade

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    Who, exactly, is "she?"
     
  11. MsMar

    MsMar Fanatic

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    I know with 100% certainty that in my district if you have proof of other insurance you can opt out of their insurance. Make sure they know you already have insurance and therefor would like to waive their insurance. It makes no sense to force someone to take it. Let's say someone has a spouse who gets family medical for free, and it would cost $200 a pay check (or $50, or $25 or whatever) for the other spouse to sign up with the new employer, why would anyone be forced to do that? Heck, some places even pay you if you opt out as they are saving money by not having you on their insurance. But the key is proof of other insurance which is equitable to the coverage you are waiving.
     
  12. GGarcia

    GGarcia Rookie

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    Yes, I told her I have other coverage and I am very happy with it. She basically said "bummer". She refers to the benefits specialist in my district. This is her first year in the position, but I would assume she would know the rules.
     
  13. dave1mo

    dave1mo Comrade

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    "Benefits specialist" sounds an awful lot like "contracted insurance saleswoman."

    I'd go above her head and talk to the HR director.
     
  14. Caesar753

    Caesar753 Multitudinous

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    You need to call HR and speak to someone else. Tell them you want to opt out of the medical coverage. Don't sign anything saying that you want that coverage.
     
  15. GGarcia

    GGarcia Rookie

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    Thank you for your replies. I appreciate your help.
     
  16. MsMar

    MsMar Fanatic

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    I agree, call HR, ask to speak to the head and explain your situation and as Caesar said, don't sign anything for the health insurance. I was just at my school to get added on to our health insurance which I opted out of for 5 years as we had coverage through dh. Due to a job change for him it now makes more sense for us to sign up with my insurance vs with his new job. On the form I filled out there is a box for "waive coverage." If Obamacare had changed things and waiving not being allowed there's no way it would still be on the form as an option.

    It's possible your employer gets a certain rate based on the number of employees they have on the plan. It's possible more employees means better rates so they insist on the coverage to keep within the number they have agreed with with the insurance carrier. It's the only reason I can think of their insistence, but I still say you should have every right to opt out. Just throwing it out there as a possibility for why they want you on it. I worked in HR many years ago and although I was never the benefits specialist, so had nothing to do with negotiating our rates, I do have a vague recollection that number of employees affected rates and rates were better the more employees you had.
     
  17. dave1mo

    dave1mo Comrade

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    That's true, because it spreads the risk over a larger pool of insured individuals; however, that doesn't mean an employer can make insurance mandatory. At the very least, it's poor policy. If it was a condition of employment, it should have been mentioned in the contract you signed.
     
  18. Ima Teacher

    Ima Teacher Virtuoso

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    You have to have coverage. You do not have to have theirs. You do have to provide them with proof of coverage.
     
  19. Aussiegirl

    Aussiegirl Habitué

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    I waived coverage because I am covered by my DH's cadillac (how long before they gut that?) plan. Not an issue. I did take life ins. and the medical savings plan where x amount of your salary goes into a pot and you can use it to cover approved expenses.

    I suggest you talk to HR as others have advised.
     
  20. lucybelle

    lucybelle Connoisseur

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    I know I was double covered my first year. I had the federal employee coverage and my dad's insurance since I was still under 26. It was great to be double covered!! I didn't have to pay a dime for an MRI of my foot.
     
  21. QE1

    QE1 Rookie

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    You do not have to take their insurance and the penalty that she was talking about has been delayed until 2015. So, they can't use that as an excuse to force you to take the coverage.

    If you do not take their plan, they do have to comp you for the benefit you would have gotten. Just bring in your proof on insurance. Also, there is generally a thirty day period in which you have to accept their insurance coverage, if you don't do it within that period you are not covered and they can not just check the box saying you care covered.

    I've worked in four different districts in four different states, along with several other jobs. There are several federal/state laws that she is breaking by forcing you to take their insurance, especially if you are not full-time.
     
  22. bros

    bros Phenom

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    You don't have to take their insurance if you already have insurance - and they won't be dinged because you aren't getting insurance, as you are already covered through another way
     
  23. GGarcia

    GGarcia Rookie

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    Thank you for all of your advice. It took a lonnnnnnnng time, but they finally said I do not have to take their insurance. We've been in school for almost two months and I just got an e-mail today. I'm wondering, since I didn't take their insurance do I get any kind of compensation. Many years ago my mom worked for a company where she didn't take their insurance and she got a few hundred extra dollars on her check each month. I'm not sure if it works that way for school districts. Anyone know if that is usually the case? I will try to contact them again, but it takes forever to get any kind of response. Thanks again.
     
  24. kpa1b2

    kpa1b2 Aficionado

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    A few hundred extra dollars/check? That would be awesome. I get waaay less then that per check!
     
  25. MsMar

    MsMar Fanatic

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    Some districts will pay you something if you "opt out" of the insurance, some will not. My first district did not, my second (and current) district does a one time payment of 80%. So if you opt out and the annual cost of insurance is $10,000 you get a check for $8,000 (well, less than that actually as taxes are taken out).

    If you ever have to get insurance with them at a later time, you have to pay back 60% of whatever the current rate is. Since health costs go up over the years, if someone opted out many years ago and then have to buy back in, it can actually cost them more money to go back in than they got in the first place. So, in keeping that in mind, not everyone who can opt out and get paid choose to do so.

    You only get the 80% once, not every year, so you could work for them for 10 years, not take the insurance, they save money on you every year but you get the payment only the first year.
     
  26. kpa1b2

    kpa1b2 Aficionado

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    MsMar, I'm curious. do you know what the reasoning is to pay back 60% of whatever the current rate is? I understand if it was within that year, but after that? What happens if the employee was using the spouse's insurance and the spouse loses their job?

    Guess I'll be happy with my measly $$/check.
     
  27. MsMar

    MsMar Fanatic

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    It's just how it's written in our contract. I'm not sure why we have to pay back in to go back in, since the district ultimately saved money. But that's how it's written and it affects so few people it's just never been brought up as part of the contract negotiations. There are always bigger fish to fry :).

    And to answer the spouse question, that's exactly what happened to me. I opted out 5 years ago, got an $8000 check and am now paying back about $5000 as we now need the insurance. Hubs changed jobs and new job only covers him so we're doing the family plan with my district. I'm having $200 per paycheck taken out to do the pay back. Kind of stinks, but so it goes. I had misunderstood the contract when I opted out (totally my own fault, I didn't read it closely enough) and thought the opt out was done yearly, not a one time thing. I thought I'd get an 80% pay out to me each year and would only have to do the pay back if I had to join that year. I probably wouldn't have done the pay out if I had realized it was a "one and done" kind of thing. But at least hub's new job came with a good pay raise so the $400 a month pay back won't kill us. The district sure saved a pretty penny on me though for the 4 years I didn't get a pay back and didn't take their insurance. So it's annoying, but fine, and honestly six years ago we really needed that $8000 and paying back the $5000 now like I said is manageable.
     
  28. kpa1b2

    kpa1b2 Aficionado

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    I was just wondering why the pay back to get in. At least you don't have to pay it all at one time. Yes, the district wins when you don't take their insurance. Kinda bums me that I get so little for not taking the insurance. Unfortunately, that's the way it goes.
     
  29. John Lee

    John Lee Groupie

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    Hi,
    I'm in a very similar situation to the OP, and I need advice. I don't have any insurance, and the district wants me to lock in my medical. I said I'd choose the PERS PPO plan, but she quoted me what I consider a high premium (~$400+/month). '

    I'd just like to know if that is generally in-line with medical coverage these days? I'm healthy, but I do have a lot of sport-related injuries that I would certainly try to address, once insured.

    Any advice would be great, cuz I'm supposed to meet with the HR person today. $400/month seems an extreme amount.
     
  30. bros

    bros Phenom

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    If it is low deductible, includes vision/dental & good prescription coverage, seems worth it. My uncle pays ~1200 a month for insurance for himself, his wife, and his daughter.
     
  31. Caesar753

    Caesar753 Multitudinous

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    That's more than I pay, but it doesn't seem terribly beyond the boundaries of standard insurance premiums.
     
  32. Rox

    Rox Cohort

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    You seem to have already resolved the issue, but if anyone else experiences something similar... check the contract. Ask them where it says in the contract that you must get insurance. If you're not required to, tell them to pay the fine. If enough employees force them to pay the fine, then they may consider shopping around for cheaper and better insurance.
     
  33. waterfall

    waterfall Virtuoso

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    So the district doesn't cover any of it? When I was last on a PPO plan, it was around 600 a month, but the district covered most of it as part of our benefits. I paid just over 100 a month. I'm now on a "high deductible" plan (the only thing my current district offers) and it is free to employees as part of our benefits. The cost to the district is just over 300 per month for an individual. They also give us about $120 per month to put into our HSA.

    When I switched districts last summer, I had to get my own coverage for two months due to differing start/end dates for the district. I got a pretty decent plan on my own for under 200 a month. If my district's plan wasn't free to me, I'd probably opt to just do that instead.
     
  34. John Lee

    John Lee Groupie

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    This I do not know.

    And BTW, thank you all for responding. The HR person just quoted me that via e-mail. The district covering a portion of it is my expectation, but then being quoted $400+ (to me), seems like that's what I'm on the hook for. When the woman quoted me that monthly rate, should I assume one way or another? I'm planning on going in to meet on Wed, but I would like some peace of mind going in. $400 is a BIG chunk of my monthly check (roughly 1/5 of my gross).
     
  35. bros

    bros Phenom

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    Assume the $400 is the employee contribution - you could also check their board of ed meeting minutes last year when they did the budget, check the stuff for employee contribution for health insurance
     
  36. czacza

    czacza Multitudinous

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    In NJ, employee contribution is pretty much state mandated. You wouldn't find anything about it in my district's board minutes.

    http://www.state.nj.us/treasury/pensions/reform-2011.shtml
     
  37. John Lee

    John Lee Groupie

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    Thanks. Bottom line is that I want to know whether a PERS Select plan (as opposed to a myriad of Blue Cross, Blue Shields, HMOs) is the way to go. If I am paying that amount, I certainly do intend to use it (medical services). I've got a knee that needs to be scoped, I need to go to the dentist, I also certainly need shoulder surgery, physical therapy on my neck... So I suppose it will be worth whatever insurance I have.
     
  38. bros

    bros Phenom

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    My district's board minutes list the contributions that you make if you cover yourself/you and a spouse/you and children/your full immediate family
     
  39. czacza

    czacza Multitudinous

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    Interesting.

    That's not the sort of thing discussed in open at my area board meetings.
     
  40. bros

    bros Phenom

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    It's usually just listed as an agenda item for the board to approve, since they state who they have healthcare through. I think they do that when contract negotiations are done
     
  41. czacza

    czacza Multitudinous

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    Seems like what the DISTRICT is paying into healthcare for employee benefits would be shared as part of budget planning. Not sure why the public would care to know what plan options faculty and staff were paying into. Salary is public knowledge and thse who truly are interested could figure out employe contribution based on the state formula. (although much of this can be gotten under OPRA, just not understanding why they use meeting time and energy looking at or discussing each employees' contribution...seems a lump sum figure of total employee pay in would be all that was necessary )Contract negotiations only came into play under the new healthcare guidelines in NJ when districts had not yet settled new contracts when the increased employee contribution legislation went into effect...you wouldn't pay the increased percentage until after settlement.
     

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