Weird Group Clause

[BKrocko]

That's what I'm talking about! This guy is a house painter (outside) and goes up and down the ladder/scaffling etc. I can also see plumbers/lawn care/handy man/etc.....I never knew about that clause, It is a hugh hole in group coverage for self employed spouse's.

The fact that they also want to keep the group coverage for him in this situation is problematic. The person at Aetna was also questioning if coverage would apply to "on the job injury" using an individual policy for all cases. I explained that WC would not be a player in this situation because there is none. She was still insistent that it may not be covered but did not know definitively. I think she is wrong but if she is correct, that would really suck. If individual policies don't cover OTJ injuries, the only solution is to pick up the tab for WC on themselves.

 

[BKrocko]

It appears that in CO, so long as you waive your rights to WC - you would be covered for an OTJ injury under an individual policy. That's good.

 

[J.R.]

How does somebody go about waiving that right in CO and what source was used? I don't doubt you, just would like clarification.

 

[Crabcake Johnny]

You can do that in MD to. The business owner can decline worker comp on himself and just have it for his employees. The theory is you can't sue yourself.

 

[BKrocko]

John's answer is correct.

 

[Crabcake Johnny]

I bring that up and have sold a few policies when I mention that to small biz owners who have a group plan. I ask them if they opted out of workers company. If they say yes I inform them that they most likely do not have coverage on the job and to call their insurance company to verify.

 

[arnguy]

If this guy wants coverage for accident on the job wouldn't a Hospital and Accident policy work for him?

 

[BKrocko]

arnguy - That is also a possibility but I have never liked limited plans. He will get an accident policy no matter what but I will need to research hospital plans. Valid suggestion - thank you.

 

[somarco]

A lot of the accident plans are non-occ as well. Can't say about HIP.

 

[LGilmore]

I think he is still screwed as he is a dependent under his wife's plan right now. I know our state allows business owner's to waive wc requirements under "Their" plan, a plan that they own and pay premiums on. Right now, his otj injuries could be rejected the way he is set up. If anything, you might have a strong basis for a sale just on that factor.

An insurance carrier "agrees" to waive the WC requirement aspect on the owners of a business... not employees dependents.

Also while he can stay as a dependent on his wife's plan, if he buys another (and he should) her plan becomes secondary payer so even if he went to a high deductible, her plan wouldn't pay until afterwards.

at least here that's how it works.