299A.465 Continuation of Health Insurance Benefits and Cash Waivers
In Minnesota, a police officer or firefighter who suffers from a physical or mental condition that limits their ability to perform the normal duties of their position for a period of at least one year, and where that condition is the direct result of an injury or illness arising out of or incurred during the performance of inherently dangerous duties, is eligible for Public Employees Retirement Association (PERA) Police and Fire Plan Duty Disability benefits. In turn, a police officer or firefighter who is determined to be eligible for PERA Duty Disability benefits is also eligible for Continuation of Health Insurance Benefits in accordance with Minn. Stat. § 299A.465. State Troopers, DNR Officers, and BCA Officers who are determined to be eligible for Duty Disability benefits under the Minnesota State Retirement System (MSRS) State Patrol Plan are also eligible for this benefit.
Minnesota Statute 299A.465 Continuation of Health Insurance Benefits
This statute provides, in relevant part, that any peace officer or firefighter who is deemed to be eligible for Duty Disability benefits, is also entitled to Continuation of Health Insurance benefits. In other words, the officer or firefighter’s employer shall continue to provide health insurance coverage for the officer or firefighter, and the officer or firefighter’s dependents if the officer or firefighter had family coverage at the time of injury. The employer is required to continue paying the employer’s contribution for said health insurance coverage until the officer reaches, or would have reached age 65, in the case of dependent coverage.
Given the ever-rising cost of health insurance, this benefit can be worth hundreds of thousands of dollars for a disabled police officer or firefighter. It also means that it can costhundreds of thousands of dollars for the officer or firefighter’s employer. Notably, an employer does have the right to contest via administrative contested case hearing whether an officer or firefighter is eligible for these benefits, and Meuser Law Office, P.A. is frequently involved in litigation on this type of case.
Health Insurance Cash Waiver Incentive Plans
Health insurance costs have risen exponentially over the last several years, and there is increased uncertainty in the markets given the political maneuvering over subsidized insurance. Some public employers have sought to reduce their health insurance costs by offering their employees incentivized alternatives to health insurance coverage through their group health plans. One such alternative that we are seeing more and more frequently are cash waiver plans.
Cash waiver plans can be offered in a variety of ways. In general, they offer an employee the option of waiving health insurance coverage in exchange for some form of monetary benefit. For example, we have handled cases involving:
- An annual cash benefit offered as an alternative to family coverage for those employees who are eligible for family coverage, but choose to waive it
- A monthly cash benefit, paid as an increase in the employee’s monthly salary, for those employees who waive single coverage and are able to demonstrate coverage elsewhere
- A monthly employer contribution towards a Health Care Savings account on a high deductible plan where the employer required two married officers to waive their respective single coverage plans, and enroll in a family plan
Cash waiver plans invariably also provide that if the person waiving coverage loses their alternative coverage elsewhere, they will have the option of re-enrolling in the employer’s group health plan. These plans also generally allow an employee to opt out of the cash waiver plan and to re-enroll in the employer’s group health plan during annual enrollment.
These types of plans are perfectly legal, and they unequivocally save an employer substantial amounts of money in the form of reduced premium costs for insuring their employees. Since they come with a cash incentive – sometimes worth several hundred dollars a month – it can be financially advantageous for an employee to elect coverage under these types of plans.
Litigation and Case Law Update
The problem with these cash waiver plans; however, is the uncertainty that they generate in the context of statutory § 299A.465 continuation of health insurance coverage eligibility if an officer or firefighter loses his or her job due to a work-related injury. We have been involved in litigation on several cases where the employer has argued that an officer or firefighter who had been enrolled in a cash waiver plan at the time of injury gave up their rights to continuation of health insurance benefits under Minn. Stat. § 299A.465 and are therefore not eligible for any ongoing cash payment or insurance coverage.
Unfortunately, the statue itself says nothing about how the law is to apply in this circumstance, but thus far, the courts who have heard cases involving cash waivers have generally held that the policy reasons behind § 299A.465 – providing access to health insurance coverage to disabled police officers and firefighters – should guide how the law applies in these cases. Here’s how a few of these cases have been determined in the courts so far:
- Administrative law decision – An officer with PTSD primarily due to traumatic incidents experienced while employed by a major metropolitan city, subsequently became employed by a smaller city in outstate Minnesota. The symptoms did not become disabling until the officer had been employed by the smaller city police department for a few years. The officer was determined to be eligible for PERA Duty Disability benefits, and PERA ordered the current department to pay health insurance. The current employer appealed and joined the officer’s prior employer to the litigation. Both cities argued about the cause of the PTSD – in other words, which of the employers was “more” responsible for the officer’s PTSD. But, the current employer also pointed out that the officer opted for a cash waiver benefit and waived health insurance coverage, and that therefore, they were not required to continue offering insurance. The current employer moved for summary judgment on this issue. After a summary judgment hearing, the administrative law judge held that the employee electing a cash waiver plan rather than health insurance coverage did not waive eligibility for insurance, and that the employer was required to continue to offer the opportunity to enroll in their group health plan. The parties, including both of the officer’s employers, subsequently reached a settlement on a cash basis.
- District court decision – An officer with PTSD had been deemed to be eligible for Duty Disability benefits by PERA. The employer enrolled the officer in single coverage and had continued said coverage for a number of years. Prior to termination from employment, the officer had elected to waive eligibility for family coverage in exchange for an annual cash incentive. The employer argued the officer was not entitled to either the cash payment on an ongoing basis, or the family coverage. The District Court held that the City was not required to pay the cash payment, as Minn. Stat. § 299A.465 did not specifically describe cash payments as “insurance;” however, the Court did hold that the City was required to offer the officer the opportunity to elect family coverage, rather than just single coverage.
- Consolidated district court cases – three cases involving police officers and firefighters from the same employer were consolidated for the district court to address the cash waiver issue. In all three of the cases, the officer or firefighter had enrolled in a cash waiver plan prior to their disabling injuries, meaning they received a monthly cash payment from the employer rather than health insurance coverage through the City. There was no dispute that all three were disabled as the result of injuries in-the-line-of-duty. The City argued that by having waived coverage in exchange for the cash incentive, each of the employees had given up their right to claim continuation of health insurance benefits in accordance with Minn. Stat. § 299A.465. In this heavily contested case, both parties moved for summary judgment. The district court found in favor of the disabled officers and firefighter. The judge found that the disabled officers and firefighters had not waived their rights to benefits in accordance with Minn. Stat. § 299A.465 but left it up to the employer as to whether to pay the cash incentive or to offer the officers and firefighters the opportunity to enroll in coverage.
If you are a Minnesota police officer or firefighter who has experienced a significant work-related injury, contact Meuser Law Office, P.A. for a free, no-obligation case evaluation and consultation. The knowledgeable attorneys at Meuser Law Office, P.A. take the time with each client to help determine which benefits under the Minnesota Workers’ Compensation Act you are entitled as well as discuss PERA Duty Disability benefits and Healthcare Continuation Benefits under Minnesota Statute § 299A.465 and help guide you through the complex process to ensure your rights are protected. Call us today at 1-877-746-5680.