Q: Should I try to get my company to put an autism benefit into our health plan or expand the existing benefit?
A: Asking this question can be very risky. If you ask your employer to put an autism benefit into our health plan, you may lose existing coverage or waive your privacy rights.
We would all like to think that our employers are compassionate. While some businesses are managed by compassionate mangers, corporations are required to act in the best interests of the shareholders. Claims for behavioral therapy to treat an autism spectrum disorder can be very high. From an actuarial perspective, such costs may not be significant when spread across a large base of employees. However, particularly for small business plans and self-insured plans, employers are likely to be concerned about unusually high costs incurred for an individual employee.
The Health Insurance Portability and Accountability Act (HIPAA) creates privacy rights that prevent your employer from accessing employee claims information to learn about medical conditions, whether or not your plan is self-insured. If, in connection with making such a request, disclose that a family member has been diagnosed with an autism spectrum disorder, you will have waived your privacy rights. Even if you do not mention it specifically, making such a request is likely to cause your employer to think you are making this request because a family member has been diagnosed with an autism spectrum disorder.
If you disclose, or suggest, that a family member has been diagnosed with an autism spectrum disorder, the biggest risk is that your employer may terminate your employment in anticipation of excessive medical costs. This risk is enhanced if the plan is self-insured. See below “Q: Isn’t it illegal for an employer to fire an employee that causes the company health plan to incur excessive medical costs?” See also “Q&A: ERISA Preemption – Basic Information – Q: What is a self-insured (self-funded) benefit plan?”
Q: Can I start an anonymous campaign for autism benefits?
A: Puzzle Ribbon helps families collaborate with self-insured employers to offer Autism benefits. Go to puzzleribbon.com and start a campaign. You can join anonymously if you prefer.
Q: Should I ask my company to sponsor a charitable event that benefits children with autism?
A: Such a process involves risk. See “Q: Should I try to get my company to put an autism benefit into our health plan or expand the existing benefit?” You can minimize that risk by not mentioning that you are interested in the charitable event because a family member has been diagnosed with an autism spectrum disorder.
Q: Isn’t it illegal for an employer to fire an employee that causes the company health plan to incur excessive medical costs?
A: Yes, termination of employment under those circumstances may be discriminatory, may violate HIPAA, or otherwise be unlawful. However, successfully bringing a claim is much harder than you might expect. First, accessing the necessary proof may be difficult. It is unlikely that an employer would actually admit terminating an employee for an employee that causes the company health plan to incur excessive medical costs. Even worse, in some cases, a lawsuit may not be a viable alternative and the only recourse may be reporting the employer to the Department of Health and Human Services (HHS). In that case, while the employee might be entitled to reinstatement, they would not be entitled to compensation for loss of employment. For most, that result is rarely worth the effort.
These general answers may or may not apply to your specific circumstances. You should consult a lawyer or other specialist if you think you are entitled to benefits that you do not receive or if you think your rights have been violated. Behavioral Lifeboat can help you do that.