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Small Company
Jan 29, 2014

Hello, I have always been covered medically through a school systems group insurance. However, recently I have changed jobs. I now work for a small company who do offer benefits for their employees but only 15 take advantage. My question is: If I choose to sign up for their insurance will their rates go up? I am currently taking Complera, which retails for $2500 a month. I remember years ago reading a post on here where the employer found out that a particular employee was running up the rates. Is that possible or better yet is that legal?

Response from Mr. Chambers

You raise a couple of issues in your questions. You ask if your joining the small group plan can affect the group rates. Chances are, it will not have an effect since most insurance companies pool groups of that size with many other similar groups.

There may some exceptions to that depending on what state you live in. There are some state insurance laws that allow insurance carriers to adjust the rate annually on a group based on the current make-up of the group. Where that occurs, however, the carrier is usually prohibited from increasing the rates more than a set percentage by law, such as no more than a 10% increase.

You also mentioned a case where the employer found out that a specific employee and his or her medical bills were high enough to cause the group rate to go up. Employers are generally not able to discover which employees are running large medical bills, but that doesn't mean it can't happen. It does, however, mean that such cases are extremely rare and usually the information is given out illegally. Employers do not have the right to know why an employee is incurring medical charges nor is having a lot of medical charges a valid reason to terminate someone.

Good luck, Jacques

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