Is insurance mandatory for dependents?

October 3, 2012 11:15 AM

Is an employer in New York required to extend health insurance coverage to the employee's spouse and dependents?

I work for an employer in New York. This employer has more than 50 employees, but is not a huge corporation. I am eligible for health insurance coverage for myself through this employer, which I have been using.

I would like to add my spouse and dependents onto my insurance plan, because my plan involves zero contribution from me. The company would prefer not to do so, as their costs would rise by a lot. They proposed to give me a raise in salary, but only if I moved all of our insurance to my spouse's employer-based insurance.

From my perspective, either the status quo (lower salary and only me on my insurance) or the proposal (higher salary but all of us on my spouse's expensive and not quite as good insurance) is just about even, money-wise. Benefits to me would be a correspondingly higher employer contribution to my retirement and a history of salary increases for my career path, as well as bringing me more in line with the salary for my level of position in my industry. There would be no change in my spouse's salary or anything. I know that there's not a whole lot more room in the budget to negotiate for a higher raise, and I'm a terrible negotiator going up against two excellent negotiators.

Are they even allowed to refuse to cover my spouse/dependents, if I myself am eligible for coverage? What legs do I have to stand on to negotiate?

posted by anonymous to Work & Money (4 answers total)

Have you proposed adding them to your insurance and covering most/all of the difference? That seems to be the most common solution to this, although it's obvious from this your boss is just trying to keep his costs down: if you get cancer and can't work, he can lay you off once you've expended your sick leave, if your wife gets cancer, you can keep working and his insurance costs will go up and up.
posted by Oktober at 11:28 AM on October 3, 2012

Since employers in NY aren't required to provide health insurance at all, it's hard to imagine that they'd be required to extend it to the rest of your family.

...as well as bringing me more in line with the salary for my level of position in my industry.

I think this is your only real leverage. If you're sure that you are currently underpaid, then you should be negotiating for raise that does not involve a sacrifice like moving even your own insurance to your spouse's employer. Currently they're offering you a "raise" that on balance may actually hurt you and save them money.
posted by jon1270 at 11:40 AM on October 3, 2012 [1 favorite]

I thought that one of Clinton's initiatives was that if a parent was covered, so must the children be. I don't know that the employer must offer it, however. According to this, if they don't currently offer it, they aren't required to do so.

Same Benefits/Same Price. Any qualified young adult must be offered all of the benefit packages available to similarly situated individuals who did not lose coverage because of cessation of dependent status. The qualified individual cannot be required to pay more for coverage than those similarly situated individuals. The new policy applies only to health insurance plans that offer dependent coverage in the first place: while most insurers and employer-sponsored plans offer dependent coverage, there is no requirement to do so.

This is in the context of teens and young adults, but I believe it applies to all dependent children.

Everything I'm reading says no one is required to offer dependent coverage but if it is offered, they can't turn your application down.

I can't find the original Clinton ruling who said if parents are covered, so must children be, but even then, it wasn't "employer who provides insurance MUST OFFER DEPENDENT COVERAGE" it was "if you're going to ensure yourself, you must find insurance for your children, too".
posted by tilde at 11:42 AM on October 3, 2012

Keep in mind that ERISA (and probably NY state law) requires an employer (unless this is a government entity or church) to follow the terms of the plan (the carrier contract plus any additional terms that wrap around), so if the plan covers dependents, you should be able to enroll your dependents - I'm not sure why this is coming down to a negotiation. Some plans might have a waiver incentive, but that should normally be a specific plan provision, and I find the wording that your employer would "prefer not to" have your dependents enrolled odd.
posted by Pax at 5:52 AM on October 5, 2012