Shifting deductible, mid sized graded funded plan

Jan 16, 2019

  1. JamesP
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    JamesP New Member

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    Does anyone know if on a graded self-funded group employer health plan, can an employer implement a higher deductible for spouse and family coverage than for employee only coverage? 155 life group in Florida. Currently, they have a $3000.00 ind. $6000 family. I’m trying to get creative here. The owner would like to drop employee’s deductible to $1500 and increase spouses and families to $4000. Anyone have suggestion? Thank you.
     
    JamesP, Jan 16, 2019
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  2. ABC
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    ABC Guru

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    Use an HRA, may have some contract issues with reinsurance.
     
    ABC, Jan 16, 2019
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  3. leevena
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    leevena Guru

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    Am I misunderstanding you? You say the currently have a family deductible of $6,000 and you want to increase it to $4,000...makes no sense. If you want to raise the plan deductible you need to coordinate with administrator. May not allow it.
     
    leevena, Jan 16, 2019
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  4. JamesP
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    JamesP New Member

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    Sorry, wasn’t clear, No they currently have a $3000 ind. $6000 family, they want the individual deductible lowered to $1500. And family increased to $4000. Rep told me today they could, still waiting for proposal. Idk, it’s been a trying group, to say the least.
     
    JamesP, Jan 17, 2019
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  5. leevena
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    leevena Guru

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    JamesP, my guess is that these changes will have little overall impact to the costs of the program. Let us know later. Thanks.
     
    leevena, Jan 18, 2019
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  6. JamesP
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    JamesP New Member

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    Yes, you are correct. The employer wants to discourage the spouses from taking group coverage, although they must not have other group coverage available, he thinks there are too many spouses on the plan. This group is a little bit of a headache, to say the least! Thank you.
     
    JamesP, Jan 22, 2019
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  7. leevena
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    leevena Guru

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    Other things the group can do, no contribution towards dependent coverage or make plan available to employees only.
     
    leevena, Jan 22, 2019
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  8. JamesP
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    JamesP New Member

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    Thank you for the suggestions! This group is a bit of a pain, well the owner is. He wants to discourage the spouses from taking coverage, yet he’s only charging them approximately $233 a month for the coverage. I told him to increase that, and he said he didn’t want the employees to have additional deductions, as he pays them terribly low wages. He runs the company like they’re in the military. He has two employees who’s spouses make a ton of money, but are self employed, and he’s mad because he pays their insurance. He wanted to exclude them, I let him know this was not legal, and he continues to try to find a way to accomplish it. Uggg!
     
    JamesP, Jan 30, 2019
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  9. Michelle Chase
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    Michelle Chase New Member

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    There is a solution!!! If you would like to discuss further please message me. The group information should stay private.
     
  10. leevena
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    leevena Guru

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    What is the solution?
     
    leevena, Apr 25, 2019
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