Are daredevils entitled to the same health plan choices as everyone else?


Under your company's group health plan, all employees generally may enroll within the first 30 days of employment, and they have a choice of a preferred provider organization (PPO) or a health maintenance organization (HMO). However, individuals who participate in certain dangerous recreational activities, such as motorcycling, only have the choice of an HMO. Could this violate any rules?


Yes. According to the Department of Health and Human Services (HHS), excluding people from the PPO because they participate in recreational activities — even dangerous ones — is a rule for eligibility that impermissibly discriminates. More specifically, the HHS states that group health plans are prohibited from discriminating against participants and beneficiaries based on a health factor, and health factors include "activities such as motorcycling, snowmobiling, all-terrain vehicle riding, horseback riding, skiing, and other similar activities."

Source: HHS Reg. §146.121(A)(2)(ii); Employee Benefits Management Newsletter, 629, March 7, 2017.

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