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Must I now get health insurance from my employer?

What info. does an employer get from a health insurance company regarding an employee.?

  • My employer stated they had two employees that cost our group plan a lot of money and that is why our premiums are raising. Does an insurance company give them a break down of who costs what??? Now it seems like there is a target on me. I had cancer.

  • Answer:

    Depends on the state and the type of plan they have. If the plan is self funded the employer will see costs as they have to pay some or all of it. While they get to see costs they will not know who in-cured those costs. Often times it is a dependent that has the expense and there is no way to tell who had coverage. Typically small groups will not use utilization to determine premiums. They will use book or community ratings. As if many small group were bundled together for the purpose of calculating rates.

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For a small group plan, less than 25 employees, the price is based on "claims". So they'd get a total dollar amount of claims paid out, to justify the rate increases. Now, it's pretty easy to figure out who's really really sick, or who needed a ton of surgery, because they took time off!! So the insurance company doesn't say who used up how much in claims . . . they'll just say, oh, you had $2,000,000 in paid claims last year, and the employer will think, "Is it the guy who hasn't missed a day of work, or the guy who took 12 weeks FMLA off for chemotherapy?" Not rocket science, but the insurance company doesn't give them that breakdown.

mbrcatz

You are not a target. I am sure your employer has reinsurance to cover anything over their limit. They get dollar amounts and amount of claims. Your employer was wrong in telling anyone it was two people. That is supposed to be confidential.

~~A employer absolutely gets no medical information about any employee without the written consent of the employee. So they are basing it on the two employees who have talked about their problems or from excessive work time missed.~~

debijs

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