How cash in lieu could really screw you

I was recently asked if an employer can offer cash in lieu if the employee uses it to purchase individual coverage. And secondly, can they give the entire amount that the employer would have otherwise spent if they enrolled on the group plan? Here are some reasons why you don’t want to do either of these things. 1: You can only allow someone to join your group health plan outside of annual open enrollment with a qualifying event that triggers what is known as HIPAA Special Enrollment Rights. You do not have special enrollment rights for dropping an individual plan, nonpayment of individual premium, shrinking of their medical network, a scary diagnosis, etc. So your employees who lose or canc

Anthem quitting Individual in NorCal 2018

CoveredCA announced today the 2018 Individual Rates today (see pdf below). Included in this announcement is the news that Anthem will now completely pull out of the North Bay (Marin, Sonoma, Napa), Sacramento, San Francisco, Santa Cruz/Monterey as well as all of Southern CA. Anthem had a lot of troubles in 2015 in the Individual Market. They tried to offer an affordable plan with a much narrower "Pathway" network. The roll out of that network and provider contracting left a lot of doctors and members disgruntled. Anthem has continued to lose participation as they narrowed and tiered their networks and yet still had higher premiums than Blue Shield. Blue Shield, bravo and thank you for stayi

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