Can my company decline to offer health insurance because I live out of county?

Asked 11 months ago - Newport Beach, CA

My branch is located in Newport Beach (less than 50), and I live outside of Orange County. They stated they won't disclose coverage or premiums until we all signed applications and found out that because I don't live in the county (like my coworkers), they won't provide me health insurance despite finding a doctor in the network in my area of residence. They're asking me to submit a new doctor in the area or to provide the address of a friend/family member within the county; otherwise not only will be denied coverage, but my coworkers will have to wait until this is accomplished. Our "open enrollment" ends this month, and we still haven't received any information. I work full time.

Attorney answers (2)

  1. Martha Ann Knutson

    Contributor Level 11

    1

    Lawyer agrees

    Answered . So, it's hard to know what's going on here. You don't necessarily have a right to have the plan pay for a doctor that's close to your home or even the one you most prefer.

    But geography, as in where its employees live, is a rating factor for what the insurance will cost your company. You should NOT misrepresent where you live on an application for insurance - because that can get your insurance cancelled if the insurance company finds out, to say nothing of potential consequences to your company if they encouraged or required it. I suspect there is a misunderstanding being spread about as "policy".

    If you are in a branch of a larger company, my suggestion would be to get someone at headquarters HR to explain this to you. Somewhere along the chain "they" have gotten their wires crossed. If there is no headquarters, keep pushing up your own chain of command.

    Good luck.

    This response is intended to provide general information, but not legal advice. The response may be different if... more
  2. Timothy John Broussard

    Contributor Level 12

    1

    Lawyer agrees

    Answered . I agree with the prior answer. When you refer to "Branch" it appears your office might be dealing with an institution and directing your questions to the "main branch" HR department would be a good idea. If you have found a primary care physician, within network in your residence, then this should not be as draconian as informed by your branch office, or misrepresenting the location of your residence.. Many employees work out of county (particularly from Newport Beach). But, it is not typical to cancel coverage, or exclude employees. Perhaps this is an error in enrollment of the wrong policy for this branch as well. Now, as for employment issue, unless your part of a union and this was set forth in a Collective Bargaining agreement, your employer has a right to cancel or limit benefits. Denying benefits from "out of county" employees does not appear to be discrimination, per se. I guess it is possible the insurance plan is only within county, but doesn't appear to be common.

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