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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?
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Answer: |
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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