Unitedhealthcare/Goldenrule Payor Question

[jmarkk1]

In Ohio, does anyone know if there are any problems with an employer paying for the health insurance for a wife and kids that want to go on their own health plan while leaving the husband on the group plan?
I'm looking at UHC/Goldenrule for this family. The broker guide isn't too clear if there are any problems with the employer paying for their coverage.

Any ideas?

 

[CHUMPS FROM OXFORD]

I believe there is a question on the application addressing that. Or perhaps it is in the signature portion where you have to abide by certain things regarding the payor.

Pull up a current app and you'll see it.

 

[jmarkk1]

I believe there is a question on the application addressing that. Or perhaps it is in the signature portion where you have to abide by certain things regarding the payor.

Pull up a current app and you'll see it.

The app asks who the payor is if not the insured. But I can't find anything that says it's ok/not ok for the employer to pay for the insurance coverage.

What's happened is their employer just stopped pay 100% of everyone's premium on the plan. They are now only paying 50%. The employee can't afford to pay 50% of premium for his wife and kids. So, the employer has agreed to pay for coverage for her and kids. (she's not an employee of the company)

If Goldenrule/UHC gets a check every month from this company will this be a problem?

 

[dgoldenz]

Yes it will be a problem. App says (at least in VA):

This insurance coverage is not designed nor marketed as employer provided insurance. This coverage does not comply with all your state’s small-employer group health insurance laws. Therefore, this plan cannot be used, now nor at some future date, by you or an employer to provide health insurance for employees.

I certify that:
(a) I am not employed by an employer with 2-50 employees; or
(b) I am employed by an employer with 2-50 employees; however, no portion of the premium is paid, either directly or indirectly, by my employer.

If you cannot certify to either (a) or (b) above, you are not eligible to apply for this plan.

I understand that my premium cannot be paid with an employer check unless I am certifying under (a) above or my employer has set up an Employer Payor account with Golden Rule.

By signing below, I certify that I understand that I am applying for personal health insurance that may never be used as employer provided insurance.

There is nothing to stop the employer from giving the employee a raise, but the income will be taxable. I don't know what's involved with the Employer Payor account but I'm sure you can call UHC and find out.

 

[somarco]

I haven't had a reason to do business with GR in a while, but I believe they had a special form for the employer to sign if they were paying the premium.

I had a small medical office set up with GR a few years ago where the doc paid the premium for himself and his staff. He did have to sign a form that was cosigned by the staff.

We switched them to Humana with GR premiums became excessive and had to fill out a similar form.

 

[Yagents]

Althought I have never done it before, GR does List Bill. I'm sure it's for more than one employee, but the employer gets one large bill, pays it, then ER is supposed to get the money back from the employee (In essence). They are also pushing "defined contribution", but that's the ER reimbursing the employee who paid out of pocket for the premium. (HRA)

Some of my self employed clients set it up with auto pay from their business accounts, and will be accepted on the online app as other payor. But bank draft is probably not an option in this situation.

Maybe have the bill sent to the business address for payment. But then, all correspondence will go to them.

If you call and ask, the answer will be that this is individual coverage, and must be paid by the individual.

Legally, if there are other employees, this is called discrimination. The only way to avoid it is with a raise. Looks like taxable income to me.

 

[somarco]

No matter how you cut it, the premium is taxable income unless you have run it through an HRA.

 

[jmarkk1]

Thanks for the input.

When I first came across this issue I thought it to be a sort of gray area because the money that would be going towards the premium would actually be coming from the employee's paycheck via a payroll deduction. So, in "theory" the husband would be paying for the coverage, not the employer.

I've gone back to them and told them that they had to be the ones that end up paying the premium from their own account, and the employer just needs to give them a pay raise, etc. to cover the premium.

 

[cwlives]

The State of Colorado passed a law allowing small business employers (< 50 employees) that have offered group coverage in the last year to reimburse employees for individual insurance. United will not sell individual plans where this reimbursement will take place.