Do i have to provide proof of health insurance to my employer

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Employer-sponsored health insurance plans are often more affordable than seeking coverage on your own. But you may be wondering: Can I decline employer health insurance?

Rest assured that you usually aren’t required to accept your company’s health insurance coverage, although some restrictions apply.

It may make more sense to decline employer health insurance and opt for a plan through the Healthcare.gov marketplace, directly from a private health insurance company, or through another source, such as Medicare or Medicaid.

Learn the advantages and disadvantages of employer health insurance vs. an individual health plan. Crunch the numbers carefully and determine which choice is best for you. And learn how to get medical insurance if you leave your employer.

Key Takeaways

• Employees are typically allowed to reject an employer’s health insurance plan, but some rules apply.
• Employees will usually pay more out-of-pocket for private or outside health insurance plans than for an employer’s group health insurance plan.
• An employee may be able to negotiate a higher salary if they decline their employer’s health insurance coverage.
• If an employee declines their employer’s health insurance plan, they may be able to enroll in it later during an open enrollment period.

Here are three reasons why a person may reject employer health insurance:

A plan’s premiums and out-of-pocket costs

Most employers cover 60 to 80% of the costs of their health insurance, but they’re only required to cover at least 50% by law.

Kaiser Family Foundation estimates that the average annual premiums for employer-sponsored health insurance in 2021 were $7,739 for single coverage and $22,221 for family coverage. Employers picked up well more than half of those costs.

The average single coverage premium workers paid was $1,299.By contrast, average 2022 benchmark premiums for Affordable Care Act (ACA) insurance plans, according to the Kaiser Family Foundation, are $438 a month or $5,256 a year.

“Depending on your employer’s contribution, a significant amount of the expense may be deducted from payroll to cover the employee’s remaining portion of the premium,” explains Jacquelynn Neat, president/founder of Indigo Care Partners in Overland Park, Kansas. “Also, if you need to enroll a spouse and/or dependent child, it may be less expensive to seek alternative plans, such as those available at Healthcare.gov.”

A spouse can get a better health plan

Alex Kronk, owner of HealthPlanCritic.com in Raleigh, North Carolina, notes that many opt to turn down medical employer health coverage if a spouse has a lower-cost plan with better health benefits.

A plan’s provider network

Employees may decline an employer plan if they find that their providers and hospitals don’t take the insurance plan.

How are group and individual medical coverage different?

Employers design group health insurance plans. So, they decide on the health insurance company, network, copays and deductibles. This health coverage is only provided to those who are currently employed as well as their dependents in many cases. Nick Schrader, an insurance agent with Texas General Insurance based in Houston, said employer sponsored health plans aren’t individualized.

However, people may find coverage for individuals and families through the ACA exchange or directly from insurance companies that better fit their needs. That way, they can choose the copays and out-of-pocket costs and the benefit design, such as a health maintenance organization (HMO) or preferred provider organization (PPO), that make sense for them.

A plan’s benefit design influences such vital parts of health insurance as to whether you need referrals to see specialists and if you can visit doctors outside of the plan’s network.

“Self-purchased plans, such as those offered at Healthcare.gov, are chosen by you — you can select the deductible, copay and network that best fits your needs,” Neat adds.

However, your marketplace options can depend partly on your ZIP code.

“In some areas, there are very few options for individual plans, so even if you wanted a network that includes your doctor or a low-deductible plan, it may not be available.”

Here is how an employer sponsored plan compares to other health coverage options:

Find out more about employer health insurance vs. individual plans.

Employer based health insurance is often more affordable than an individual plan, but not always — and you may find an ACA plan with a better provider network.

Brian Colburn, senior vice president of corporate development & strategy at Waltham, Massachusetts-headquartered Alegeus, says that, despite the advantages of employer group insurance plans, many still choose to purchase individual health insurance.

“Oftentimes, this happens when the employee’s needs don’t match up with what the employer sponsored coverage offers. If you have unique health care needs, desire doctors and specialists out of network or want a more bare-bones plan, the individual marketplace can be a good alternative,” says Colburn.

Neat explains that it may be best to shop for coverage at Healthcare.gov if you qualify for an income-based subsidy. The ACA marketplace provides subsidies and tax credits to help people pay for ACA plans. The subsidies can save members hundreds of dollars each month, but they aren’t available for plans outside of the ACA marketplace.

“If you are self-employed or you do not have affordable options at work, an individual ACA or private marketplace plan may be the only option in your area. The good news is that ACA plans have no penalties for pre-existing conditions, so if you are struggling with a health condition, this may be your best choice,” she says.

However, if your income is too high to qualify for a government subsidy in the ACA marketplace, premium costs and high out-of-pocket expenses can be a real hardship.

“In this instance, an employer sponsored group plan may provide lower deductibles and help ease the burden of a high premium,” says Neat.

You aren’t required to accept an employer health insurance plan. You can decline or waive this benefit.

“But you may have to sign a waiver that you will be obtaining another insurance plan or accepting someone else’s insurance coverage so that your employer has proof that you are insured for legal purposes,” Schrader says.

If you decline or waive your employer sponsored coverage, you are allowed to enroll later during the employer’s open enrollment period unless you qualify for a special enrollment because of a qualifying event.

“Certain qualifying life events, such as you losing coverage not provided by your employer, getting married or having children may trigger a special open enrollment period during which you can sign up for group coverage at work, too,” says Kronk.

Also, once you sign up for employer-sponsored health coverage and agree to have your premiums deducted from your paychecks, “you can’t drop coverage during the year unless you experience a qualifying life event,” says Colburn.

And people should know that if their employer offers health insurance as part of a benefits package, they may decline the coverage if they have other health insurance coverage that meets the requirements of the Affordable Care Act (ACA), according to Fred Hoffman, founder and CEO of insurance agency Life Insurance Guideline.

“This other health insurance coverage can come from a spouse’s employer, from a parent’s health insurance plan if you are under 26 years old, or from the health insurance marketplace,” Hoffman says. “If your employer offers health insurance as part of your benefits package, you cannot decline the coverage if you don’t have other health insurance coverage that meets the requirements of the ACA.”

Can you decline health insurance for a higher salary?

It may be possible to negotiate a higher salary if you decline coverage, as waiving this benefit could save your company thousands of dollars a year.

“If you want minimum coverage and can negotiate a higher salary from your employer, you could save some money buying a low-cost plan on the ACA exchange, particularly if you are lower-income and can receive a premium tax credit,” Kronk says.

However, due to tax discrimination laws, employee benefits are typically a ‘take-it-or-leave-it’ option. Your employer may not legally be able to increase your income if you opt out of health benefits, cautions Neat.

It’s wise to crunch the numbers on this strategy before declining your employer’s health insurance for a higher salary.

“If you are going to turn down your employer’s coverage, you’ll need to get health insurance from somewhere else. If your employer’s payment in lieu of insurance is lower than your premiums would be elsewhere, it’s probably best to take your employer’s insurance. If not, take the money,” Seuthe says.

Dorothea Hudson, a Clearwater, Florida-based health insurance expert, explains how a compensation bump-up might work.

“If your part of the monthly premium would be $200, and your employer pays $100 toward your premium, then the cash in lieu of coverage amount should be $300,” Hudson says.

How long must an employer provide health insurance after termination?

There is no particular time frame when an employer must keep your health insurance coverage after a job termination. This decision is up to the company.

Some employers cancel health insurance on the day of termination. Others wait until the end of the month or a few months so that you can have extra time to seek new employment.

That being said, most employers are required to provide you access to its employer health insurance plan for at least 18 months after termination through COBRA (the Consolidated Omnibus Budget Reconciliation Act). COBRA requires that private employers with at least 20 employees offer COBRA benefits to former employees, except those fired for “gross misconduct.” Many states also have mini-COBRA laws for small businesses.

“Note that you’ll pay the full price of health insurance during this COBRA period, with no subsidies provided from your employer, so expect to pay costly premiums,” adds Kronk.

Find out more about COBRA costs.

When you might want out of your employer’s health insurance plan

Here are five scenarios when you might want to opt out of the group insurance at work and buy health insurance on your own.

Your employer offers health insurance coverage, but it doesn’t contribute enough for the premiums

The amount employers subsidize can vary by employer. If your employer doesn’t help much to pay premiums, you might find a better deal by buying an individual health plan, especially if you qualify for subsidies in an ACA plan.

Your employer offers coverage, but you think it’s a lousy plan

Under the Affordable Care Act, employer sponsored plans must cover at least 60% of medical expenses for a “standard population.” In that case, the employee pays 40% of their health care expenses through deductibles, coinsurance and copayments. Your plan will state whether it meets the percentage requirement.

Similarly, your boss could offer a plan that you think is too expensive and that you can’t afford it. However, you may find that prices on the individual market are high, too.

Note that if you decline your employer-based insurance, you’ll forfeit any financial assistance your employer offers to cover its cost. Plus, you won’t be eligible for premium tax credits for a marketplace plan if your job-based insurance is deemed affordable and meets minimum value requirements under the law.

You’re about to lose your job or you’ve lost your job and are offered COBRA

COBRA law gives you the right to continue the plan you had through your work after leaving a job, but your employer doesn’t subsidize your premiums.

Besides, if you lose coverage through a job loss, it’s considered a “qualifying life event” and you’re entitled to a special enrollment period for a health plan. So, if you lose your job after the regular open enrollment period has ended, you qualify for a special open enrollment of 60 days.

Your employer’s family coverage is too expensive

Work-based coverage is considered “affordable” if the employee’s share of the annual premium for the lowest-priced individual plan costs no more than 9.5% of annual household income. For that reason, premiums for your entire family can total more than 9.5% of your income, yet you still won’t qualify for tax credits to buy insurance through a health insurance marketplace.

If this is true, it’s smart to shop around for options, including provided by your employer and available on the private market, to determine where you can land the best coverage for your family at an affordable price.

Your providers don’t accept the employer’s health insurance plan

Doctors don’t take every type of health insurance plan. So, it’s wise to check a health plan’s provider network before signing up.

If your providers aren’t considered in-network, you may have to pay all or more of the costs depending on the type of health plan.

What health insurance covers you if you lose your job?

COBRA insurance typically covers employees who worked at companies with at least 20 employees.

COBRA allows you to extend your previous employer’s health insurance coverage, but the employer no longer helps you pay for the plan. You have to pay the entire amount for health insurance coverage, which can be substantial.

You can also go on the ACA marketplace to see what plans are available in your area. ACA subsidies can reduce your costs if you qualify. However, if you don’t qualify for subsidies, ACA plans can be pricey — though not as costly as a COBRA plan.

Another option is to get an individual plan directly from a health insurance company. Those plans aren’t eligible for subsidies, but you may find an affordable plan by working with a health insurer.

The bottom line

In summary, you are permitted to turn down your employer’s group health insurance plan in most cases. However, you may have to sign a waiver or prove to your employer that you will obtain a different insurance plan or accept different insurance coverage. Fortunately, you can enroll in your employer’s group insurance plan later during an open enrollment period or during a special enrollment period because of a particular qualifying event, such as getting married or having a child.

Additionally, if you decline your employer’s health insurance plan, you must obtain outside health insurance coverage that meets the requirements of the Affordable Care Act.

Also, you may be able to negotiate a higher salary or compensation package with your employer if you decline their health insurance plan.

It may be possible to negotiate a higher salary if you decline coverage, as waiving this benefit could save your company thousands of dollars a year.

Lastly, be aware that there is no specific time frame in which your employer must keep your health insurance coverage intact after you lose your job. Most employers are required to provide you access to their employer health insurance plan for at least 18 months after termination through COBRA.

Erik J. Martin is a Chicago area-based freelance writer whose articles have been published by AARP The Magazine, The Motley Fool, The Costco Connection, USAA, US Chamber of Commerce, Bankrate, The Chicago Tribune, and other publications. He often writes on topics related to insurance, real estate, personal finance, business, technology, health care, and entertainment. Erik also hosts a podcast and publishes several blogs, including Martinspiration.com and Cineversegroup.com.

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