A recent case prompted me to inquire about a particular individual, and I thereby learned our policies. The issue is the degree to which a company offers employees financial support for health care insurance versus limiting the company's financial exposure after a long-term illness and absence from work. I am curious if our policies in this regard are similar to other corporations out there. Please offer comments on this matter.
The specific situation is the treatment of an employee (let's call him Sam) who is forced to miss an extended period of work because of illness. First, note that we offer long-term disability coverage, so that there is some wage support after sick time and other short-term support is exhausted. Our policy, though, is to remove Sam from the payroll for health benefit purposes after one year being out of work.
For example, let's say Sam elected the plan for receiving 60% of salary for long-term disability (LTD). He will continue to collect LTD until he is able to return to work or the age of 65.
For health insurance, Sam was on the company plan, with dual coverage. The total premium was $940.63. While on the payroll, BIDMC paid $ 725.91 (78%) and Sam paid $214.72 (22%) per month.
Upon leaving the payroll, Sam is eligible for COBRA coverage for a policy with all of the same benefits, but he loses the BIDMC contribution. The cost of COBRA will be $959.44 for dual coverage. (If he elects coverage for himself, the cost is $479.72.) He will be able to remain on COBRA for 36 months.
After 36 months, Sam would be eligible for insurance coverage offered through the Massachusetts Connector Authority.
I look for the experience from others of you out there. I notice, for example, that the Federal Government uses a similar one-year rule. In the Office of Personnel Management benefits handbook, it says, "Your enrollment will terminate at the end of the pay period which includes the 365th day in consecutive leave without pay status." In contrast, if I am reading things correctly (and it is easy to interpret things wrong in the state jargon!), the Commonwealth of Massachusetts appears to have a rule that "an employee is not entitled to more that 26 weeks of ... medical leave [for the employee's own serious health condition] in a 12-month period." During that leave, the state continues to pay its share of health care insurance costs. After that, the COBRA policy kicks in and the employee pays the full amount of coverage.
Subscribe to:
Post Comments (Atom)
9 comments:
Hi Paul,
Thank you for this interesting post. I'm not sure what Sam's family situation is (whether he has a spouse who may be employed, for example) and I don't know how much he would get from the disability insurance. That said, he may be able to get help from the Commonwealth before his 36 months on COBRA expire. If he/his family are below 300% of the federal poverty level, he can apply for and likely receive Commonwealth Care- access to COBRA does not preclude Commonwealth Care eligibility. Also, depending on his health care needs, he may find that he can get a more affordable individual or family plan from Commonwealth Choice, though he would want to be careful not to choose a plan that would impose a lot of cost-sharing for his medical needs. I just wanted to put that out there in case it might be helpful. Thank you again!
Interesting post. Consider how much better off Sam and his family would be under universal coverage system that is not dependent on work status. Of course, that is unthinkable, unless you live in the U.K. or Canada.
In that regard yes, but then he might not have received treatment for certain advanced medical treatments, too.
But will any of those advance treatments help Sam, or just expose him to risk? Evidence based medicine suggests that it might be about an even chance.
Excellent point.
People with universal health care don't just get hack medicine, is that what you are implying?
No, I am stating that in many countries with universal care, while primary care is superb, there is greater rationing of higher end medical services.
As an RN who had cancer and was out of work for 11 months, I was terminated from a hospital (Charitable institution-hah) after my 12 weeks of Family Medical Leave Act were over. I continued to be covered by the hospital's STD and LTD coverage but had to start paying COBRA after the 12 weeks. My boss's boss had urged me to have my treatment there, but for many reasons, I chose not to do that. When I was ready to return to work, there were no comparable position. While I was still unemployed my old job became available. I was turned down because I didn't meet the new job requirements-(Probably due to fear about future health care costs). Did I have the skills to do the job,yes. It took me two years to get a comparable position, and my cncer was highly unlikely to return. I did a great job for the hospital who hired me although my healthcare costs are probably slightly hihger than normal.Since hospitals don't pay taxes, they should be be held to a higher standard.
As a society, we are very unforgiving of employees who become ill and recover.But since patients with cancer aren't dying anymore, rehire them.
Interesting comments-especially the last patient with the condition of Cancer-I too was terminated after a serious health condition and I had exhausted FMLA. Is this a bank or a hospital? It's ridiculous how quickly a long term employee can be let go when they are seriously ill, but yet the hospital will count on these exact staff members to take care the seriously ill that the hospital admits. What kind of institution is this? Isn't it something that these are the same employees that give their all to take care of others!
Post a Comment