New Health Insurance Question

as*wipe.

I would fire you for even thinking about lying to the benefit provider. Your head is in the wrong place brother. Be a man and be accountable for your family and its actions.

healthinsurance wrote:

I recently started a new job. It comes with good health care coverage. They charge additional premiums for smoking within the past 12 months, however. I don't smoke. My wife does. Not a lot, but socially. She has quit since we moved, but not longer than 12 months. I know that the honest thing to do is to say that she has smoked, but I am annoyed by the charge for this one health risk and not other factors and admit that I don't want to pay the premium. Smoking is still legal and there are many activities that have negative health risks that aren't taxed.

My question is - is there any likelihood that the insurance company will be able to find record of her smoking and deny us coverage?

Do you really want to take the chance? Let's say you lie. She develops some sort of respiratory issue (not anything serious like cancer, but some pulmonary issue) that is related to smoking. The insurance company decides to investigate and finds people who have smoked with her. BOOM, she is not covered and you are paying the medical bills out of pocket.

Smoking is legal, but that has nothing to do with the actuaries who make the decisions (contribute anyway) on premiums. There is overwhelming evidence that smoking increases one's risk for various diseases, so it makes sense to charge more. Insurance is that way: the more risky behaviors, the higher the premiums. If you drive your car a lot, you insurance premiums are higher. If you live in a place where car theft is rampant, your rates will be higher.

What over risk factors would you like them to charge for?

Do not lie about the smoking. If you do, the insurer can rescind your coverage. Then you're really screwed if large claims have been incurred.

Simply charging smokers higher premiums in a group health plan (one offered through an employer) might not be legal under HIPAA (Health Insurance Portability and Accountability Act). Unless the plan offers some way to avoid the premium, such as your agreement to enter a smoking cessation program.

See this article for a good summary:

http://www.lorman.com/newsletters/article.php?article_id=506&newsletter_id=109&category_id=1

Now, I'm not saying employers don't do this -- I'm just saying that if they do, they could be violating Federal law. If they don't offer a wellness program to give smokers an incentive to quit, take the article to your HR rep.

That's one problem with out healthcare system in the U.S., people can't be charged more for lifestyle decisions that raise the risk of different things. I understand why someone wouldn't want someone to pay higher premiums if they had a family history of cancer, but we're talking about behavior here. If someone behaves in an irresponsible way they ought to pay more, a lot more. This goes for fatties too.

Mtn Dew wrote:

That's one problem with out healthcare system in the U.S., people can't be charged more for lifestyle decisions that raise the risk of different things.

That's not true. As posted above, employers may discriminate covered employees, as long as wellness programs are in place.

See Federal Register, Vol. 71, No. 239, December 13, 2006.

I would opine that folks lying to their health providers is a larger problem. Folks cheating workman's comp, lack of standardized price controls, etc., etc...if you're really interested, see The Journal of Legal Medicine, Vol. 28, No. 1, January-March 2007

dotato wrote:

That's not true. As posted above, employers may discriminate covered employees, as long as wellness programs are in place.

See Federal Register, Vol. 71, No. 239, December 13, 2006.

I would opine that folks lying to their health providers is a larger problem. Folks cheating workman's comp, lack of standardized price controls, etc., etc...if you're really interested, see The Journal of Legal Medicine, Vol. 28, No. 1, January-March 2007

It's the same thing. Forcing a company to provide a stupid employee with smoking cessation assistance is silly and intrusive. It's government regulation making the cost of healthcare go up.

The law isn't forcing companies to offer "smoking cessation assistance." It merely is saying that in order to take smoking status into account for premiums, you must offer a wellness program, which can be as simple as someone certifying with their signature that they promise to start using the patch, or promise to enroll themselves in a smoking cessation program (at their own expense). It can be as simple as pledging to try to quit smoking. No extra cost to the employer, and it provides an incentive for people to try to quit = if you promise to try to quit, you don't have to pay extra premiums.

Without this law, I could see employers making the question: "Have you ever smoked?" Then, anyone who has ever smoked would either be hosed (or they'd probably lie).

I'm not saying I totally disagree with your point of view, though. Maybe it's nice of the law to provide incentives to engage in healthier behavior, but one could argue that a higher premium is enough incentive (tough love).

It'll never happen, but I'd love to see a "fat tax" in this country. For example, if your BMI is at an obese level (not counting pregnant women), your employer can charge you higher health insurance premiums. Or you'd have to pay higher medicare taxes. Maybe that would get this country to lose some weight.

Or maybe not.

Mtn Dew wrote:

It's the same thing. Forcing a company to provide a stupid employee with smoking cessation assistance is silly and intrusive. It's government regulation making the cost of healthcare go up.

How instrusive can it be if the company isn't allowed to measure success? The law also stipulates in offering the program, any benefits related to participation can not be tied to program success.

Look, I get what you're saying, but I would argue it's not enough government regulation which is making the cost of healthcare go up. Leaving healthcare to free market enterprise, without providing the consumer with tools of comparison is one of the largest problems.

If I may make an analogy. Say you need a pair of running shoes. You walk into the running shoe store and the salesman gives you what he thinks will fit your foot based upon what you tell him and maybe a couple of running tests. He then makes you pay for the shoes, and if they don't work, then you have to pay for a different pair, after some more tests.

You may go through this a few times, and then decide you want to switch to another shoe store, because its the only way you have access to a different shoe provider; there are no price or cost comparison data available to you as a shoe consumer.

Would you consider it intrusive for the government to tell the shoe distributors they must reveal prices, and make same available to the consumers?

Well, what if your employer got tax incentives to offer shoe subsidies to employees, but individuals didn't have the same opportunity? What if some people got shoes for free and never had to pay? Wouldn't the price of your shoes go up?

The gov't has created so many regulations on healthcare that people blame the free market for failures when it's anything but that. The problem is that gov't will de-regulate things to a certain extent, but leave other regulations in place that create an effect where things are worse off, even with less overall regulation. Look at what happened in California with the blackouts. That wasn't b/c of de-regulation, it was because of the kinds of regulations they kept in place.

If we want better healthcare we need more market solutions. The government is good at killing people and hiding the cost of things, that's about it. Government is responsible for tying health insurance to work, which is a very bad thing. Regulation in the form of licensing also causes problems too. There's just a ton of problems the gov't has created.

Sadly, we are going to get our socialized medicine within 10 years and we will be worse off for it. Yes, perhaps things will be more equal, but overall we will be in worse shape.

I am no attorney but back in the day I was an Employee benefits consultant, plus I took Business Law even farther back in the day. My read is, not being honest about her smoking would be Material Misrepresentation, and make the contract voidable by the insurance company. Plus of course you would be telling a lie, which your parents should have taught you was wrong.

I believe this guy is talking about group health insurance through an employer, so there is no individual policy. The employer that sponsors the group plan is asking whether any covered individuals smoke. So he'd be lying to his employer, not to the insurance company (who has a contract with the employer, not each covered individual).

Note that some employers who sponsor plans will say that if you're caught lying on any of your benefits enrollment information, you'll be subject to discipline which may include termination of employment.