Is it legal for a health insurance company to fine you for not getting a yearly physical?

My employer’s insurance option, which isn’t fully funded, now requires a yearly physical. If we choose to enroll in benefits but don’t complete the physical by mid-year, money will be deducted from our paychecks until we do. That seems outrageous to me. Is that legal?

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The health insurance isn’t fining you; your employer is.

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Yes, it is. While it might not be a fine, it’s a loss of an incentive. I often see incentive plans with patients, like lower premiums for non-smokers. Some states have banned this, but self-funded plans are exempt from those laws.

Why should an employer cover your insurance if you won’t engage in preventive care?

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I get my yearly physical and pay my fair share of insurance, so I’m frustrated about being penalized for not getting it done in their time frame. I scheduled my appointment back in March, but it’s still two weeks away. According to their rules, I’ll have been paying extra for months for something I can’t control. I refuse to change my doctor just to meet their requirements that feels insane to me.

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Just schedule your next physical now for the first six months of next year.

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Where do you live that they can demand when you have a physical? In my area, it’s nearly impossible to schedule any doctor visits within six months, and a physical often takes at least nine months to get an appointment. Plus, you have to wait at least 12 months between physicals for insurance to cover it. A rule like that would push my annual physical back by nine months.

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Next year, be sure to schedule your physical before the year’s cutoff. Women often have to plan ahead for mammograms and other care around that timeline, or else they risk paying for the entire visit and tests if they go early. Typically, there’s a 30-60 day window to complete yearly physicals and tests, and that’s been the standard.

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Where do you live that they can demand when you have a physical? In my area, it’s nearly impossible to schedule any doctor visits within six months, and a physical often takes at least nine months to get an appointment. Plus, you have to wait at least 12 months between physicals for insurance to cover it. A rule like that would push my annual physical back by nine months.

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This has been happening for at least a decade. It’s not the insurance company; it’s your employer trying to save on their share of your benefits.

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This has been happening for at least a decade. It’s not the insurance company; it’s your employer trying to save on their share of your benefits.

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Are you saying they’ll will contribute 0, or just less?

Employer wellness programs are common, although most refer to them as discounts (they contribute more if you opt in). Physicals, bloodwork, excersize programs are typical examples. For example, if I average 6000 steps per day , I get a “discount” off that months premium. “Discount” or “penalty” are the same thing depending on how you look at it.