Move Huge Claimants from Group to Exchange/ Hemophilia

[Grouper]

We all know that it is completely out of bounds for employers to incent Medicare eligibles in 20+ groups to decline the group plan in favor of enrolling in a Medicare plan.
But what about incenting a person with a hugely expensive maintenance condition, like hemophilia, to drop out of an experience rated large group plan and enroll in a guarantee issue/ no pre ex plan through their local exchange?

I expect there are no legal obstacles to that approach?
Wouldn't every employer with a catastrophic claimant in their experience rated plan benefit from getting the claimant to enroll in an individual plan unrelated to the group?
Thoughts?

 

[leevena]

Violates HIPAA and a few others

 

[Tkruger]

Violates HIPAA and a few others

I'm seeing a little more than half a dozen.

 

[Grouper]

I don't think it violates HIPAA if the claimant chooses to discuss it, maybe because they have a financial incentive to.

What are the other legal violations you refer to?

 

[leevena]

Please see DOL bulletin issued nov 6, 2014 which, among other things, prohibits employers from this and provides the various laws, including HIPAA.

 

[traceyemoon]

I don't think it violates HIPAA if the claimant chooses to discuss it, maybe because they have a financial incentive to.

What are the other legal violations you refer to?

The way the question was initially phrased made it sound as though the employer was interested in having the individual leave the plan to save having the cost be shared by the other members. If that is the case, then yes, it would violate HIPPA laws and face a few other issues.

If the individual person decides that it is in their best interest (without "help" from their employer or carrier) to go to an Exchange plan because he/she would save money, that is fine, at least it is in the FFM. They would need to be advised that they would not be eligible for a tax credit and they also need to be advised to discuss with their benefit manager or carrier to compare if they would truly save costs. Is this just to save premium costs or healthcare costs? If the exchange deductible and max OOP is much higher than the group plan's, it just may be bad advice.

 

[yorkriver1]

It's hard to imagine the FFM individual premium being lower for comparable coverage than an employer paying, say, at minimum 50% of the employee premium. That assumes the person leaving the group is an employee. There are groups that also pay a portion of dependent coverage. I haven't seen many. There are few to no individual plans on or off FFM that have wide networks. Someone who is quite ill could be referred to a large teaching hospital out of state or not in the network of the narrow local based FFM plan. These are difficult questions. A long expensive hospital/ICU stay could happen to someone with no obvious serious illness.