Is it unethical to use healthcare paid by your company to cure a life-long health problem?

Question

Background info:

I was born with a small defect in my eyes that requires me to wear glasses to be able to do any kind of personal or professional task. I've used glasses since my early childhood.

While this is a bit problematic, I never had any issues with wearing glasses. I even like to wear them, they're part of me by now.

Fast forward to my adulthood. I joined a company that offers a nice healthcare package for almost free (I contribute with 1% of my monthly income) but basically never use it, since I rarely have any health problem at all.

Recently I found out that my company healthcare package covers the cost of the operation to fix my eyes. It is not that expensive, but is also not that cheap. Since then I've been wondering if I should use the benefits of the healthcare to finally fix my eyes or not?

Additional info: If I had to pay from my own funds, I probably wouldn't start treatment: wearing glasses is not a burden to me.

Question: In this case, is it unethical to use the healthcare package to cure a problem that is personal and does not affect my professional duties?

Answer 1

You're paying for it - why not use it?

If they explicitly wanted to prevent you using it for such conditions then they would have a policy that excluded them.

Answer 2

Healthcare plans are not limited to work related problems. They are a benefit, like flexible working hours or no dress code.
If the plan covers it, there is no reason to not use it.

Answer 3

is it unethical to use the healthcare package to cure a problem that is personal [....]

No, not in general and definitely not in your case. It's completely ethical and you are expected to make use of that policy / fund for your individual betterment (for health care). Any organization, wants their employees to be fit, active and healthy - this increases productivity and positive vibe in the organization.

Health issues are always personal (or, individual). I believe it's just the nature of the health issue (a simple flu or viral fever over your eye surgery) that is causing you the the dilemma. I, personally do not see anything unethical in using company provided fund to treat a real problem you have. If not today, it will help you in long run, thereby also having a positive effect on the organization by having a healthier version of you.

[...] requires me to wear glasses to be able to do any kind of task personal or professional.

I'd say, that's reason enough to go ahead. For sake of argument, your professional work will be improved (the degree, well, depends).

Answer 4

is it unethical to use the healthcare package to cure a problem that is personal and does not affect my professional duties?

No.

Paid healthcare is compensation, like salary. A good sanity check for questions like this is to ask if it's unethical to use your salary for your operation. Certainly not.

It seems you're thinking of your healthcare benefits as a side effect of having a job, and you are afraid of exploiting it. A made-up example is using the fact that your office has power outlets to plug in a crypto-mining computer. This is unethical because you are exploiting something the business provides for a not-intended use that causes the company harm for your benefit.

Your benefits package was meant to be used for healthcare costs, so there is no question of ethics.

Answer 5

It's up to the healthcare provider to either allow or disallow claims based on the details of the policy/cost/whatever.

Ethics doesn't play a part in that decision, it's just whether or not the condition/injury is covered or not. It's as simple as that.

Ethics might come into play if you happened to join a company with the sole intention of using the healthcare benefit to cure your ailment.

Answer 6

In this case, is it unethical to use the healthcare package to cure a problem that is personal and does not affect my professional duties?

It's unclear what country you're in. I do not see how or why you can only use medical healthcare only when it aids in your duties as a employee.

You're really asking if pre-existing conditions should be included with your current health plan. I think anything can be rationalized as "pre-existing" if you think about. If you get sick, that means your immune system has a pre-existing condition where it doesn't know how to fight the new illness since it never discovered it yet. Would that mean you can't go to the doctor? I'd hope not.

Answer 7

There's a good chance that your company actually wants you to use your healthcare benefits. Most companies are not in health insurance business themselves: they pay a fixed fee to an external insurance company (which includes your contribution of 1% of salary). This fee doesn't change wherever you actually use the benefits or not. You might as well get these money's worth.

Whenever you would pay for the treatment from your own pocket is irrelevant. If you want to get your eyes fixed, then by all means, do it.

Answer 8

Health Insurance is created to cover part of the cost of your medical care - it does not (or more specifically should not) exclude any conditions you may have had before getting that health care.

That being said - if there are any concerns with coverage, you should address this with your doctor and your insurance - not with Workplace.se.

More specifically, you should see if your company has a health insurance consultant for you to talk to about this issue, and if not then you should contact the insurance company directly regarding your vision issues. You are right to be concerned, but the concern should be whether or not your insurance will cover it for you - not whether or not it would be 'unethical'.

You're paying for it already by buying the insurance. The only question you should have now is whether or not the insurance program will in fact cover it as you expect.

Answer 9

No, it's not unethical to use it.

Please note:

• Whether you fix your eyes or not, your company will still pay the same amount for the policy. You are not causing an extra cost for your employer.
• The operation would indeed cause an extra cost on the healthcare provider compared with not doing it. However, they are paid for that. The cost of the policy should have taken into account that X people could need eye surgery (even 'personal' ones¹), and include that into the price.

They might even have asked for the number of people wearing eyeglasses in order to set the policy price, but actually these are a percentage of the population and the total number of people insured, so it's not micromanaged at that level. Rest assured, they count on that and are still getting a benefit.

Finally, your company should prefer that you can enjoy the healthcare benefits it provides its employees.

So, if you are want to have that operation (at the price set by your healthcare policy), go for it.

As with any surgery, you should carefully consider whether to do it or not, but on the own risks that the operation may have. Can the operation be performed in several ways or by different people? What's the likelihood of the operation going badly? Could you end up mostly blind? Or having big headaches that ruin your life? Would that operation increase your chances of developing other eye 'issues' in the long term (even years after), for example dry-eye?

After getting advice from several professionals, you should then evaluate the associated risks and decide if you want to start the treatment to "fix your eyes" or not. But don't base that decision on the bear it imposes on the healthcare policy in which that is already included. It speaks well of you that you had such concerns, but I don't think it's a problem in any way.

¹ Just using your own terms. I don't really like calling this a 'personal' problem, it affects you as a whole, not only when you are or are not working.

Answer 10

I would definitely do the treatment if I were you.

A little bit of context: Insurance companies make money solely of people who have said insurance but never use it. And even if you do, you are sometimes better of paying in full yourself

e.g. I had a damage on my car that I caused myself, and because in such a case the insurance cost is increased, it is advised that you pay small-to-medium damages yourself, because it is cheaper. So don't hesitate to use this insurance, they are not the salvation army.

Also(even if irrelevant for your situation): in my country with general health insurance, nobody would even ask this question because it is considered standard for the insurance to pay for every medical treatment.

Answer 11

While I applaud your desire to be ethical, this isn't a question of what is moral or immoral, rather it is amoral (outside the realm of ethics). You and your employer are paying for an insurance policy to cover certain things (your healthcare) for a certain period (while you are employed with that employer, and maybe beyond, depending on contractual and legal matters), and that (usually) includes anything that you need to have done during that period. If the insurance company didn't want to pay for this issue, they would have excluded it somehow (of course, your employer may have chosen to use a different insurer).

Perhaps a couple real life examples will better demonstrate:

• As a result of the type of work I do, I have a repetitive stress injury. Eventually I may need surgery because of it (although I'm not there yet). I've been doing this work for decades, during which time I have worked for around a dozen employers; I've had even more insurance plans. If the time comes that I need surgery, which of those insurance companies should pay for it? The first? All of them, with some sort of prorated contribution? Or just the one who insures me now? Given that some of those employers and insurance companies don't exist anymore (and I don't remember every company who insured me), the only reasonable solution is to let the current insurer take care of it. If it makes you feel any better, this surely evens out as workers change jobs and employers change insurance carriers.
• A former boss of mine had a dozen children. I have 1. We were both insured through the same insurer ... and paid the same premiums, as "family premiums" were the same, whether you had 1 child or 20. Is that ethical?

As noted elsewhere, it is likely that your employer actually wants you to use your healthcare. Firstly, they surely want the best employee they can have, and that won't happen if you ignore health concerns. Specific to your situation, while you have become accustomed to wearing glasses, you might actually be more productive if you didn't need them (now that I do need them, I am amazed at how often I have to clean my glasses, remember where I left them, etc.). Secondly, they are paying for your insurance and if you aren't using it, that becomes wasted money, which they surely do not want.

Answer 12

offers a nice healthcare package

They offer the healthcare package not since they are nice or to pay for work-induced problems (depending on the place, the employer anyway would have to do that legally), but in order to give you a reasonable benefit to bind you to the company while at the same time have you happier and more productive (since your health problems will be taken care off).

So, no, this in not unethical, this is as it is intended: a benefit for you and the company.

Answer 13

In a nutshell, no, it is not unethical, as long as the plan specifically includes preexisting conditions.

The cost of your plan's premiums -- to you, your coworkers, and your employer -- is partially determined by the likelihood that the benefits will be used for preexisting conditions. So, if it does not explicitly cover preexisting conditions and you were to lie about the preexistence, you would be driving up the cost of the insurance for other people in making their premiums higher to cover stolen benefits. It all comes down to the bottom line: there has to be enough money contributed by everyone involved to cover the costs incurred by the entire group. The more benefits claimed, the higher the cost becomes for everyone.

There are a lot of misconceptions and just, plain wishful thinking about insurance. "Insurance" is a concept meant to ensure that people have a way to cover unexpected costs (be it for health, accident, early death, house fires...). Buying $1,000 of insurance to avoid paying $1,500 in medical bills is contrary to the whole idea of insurance (no matter what politicians who hunger after your votes say about it) and unethical on its face.

However, employers have long offered insurance that covers preexisting conditions as an attraction to candidates for employment -- it is a benefit that is not inexpensive, for which employers pay mightily. While many people think they are "paying" for this benefit, the amount deducted from their paychecks is typically not enough to cover the full cost. (I contribute less to my coverage than my employer does.) Regardless of one's share in the cost, it all boils down to whether the preexisting condition is meant to be covered in the policy.

Answer 14

I don't think it is unethical, you pay for it. Also, it is such a bonus you may want to search when your searching for a job.

Please also note that I don't expect that the company really pays for your operation. I think it is like an insurance: you pay a monthly amount, your company may-be also pay another monthly amount. Overall the insurance chooses an amount to make their business work.

Background: my father has such an healthcare program (Italy). He paid a monthly amount, and his company also paid another monthly amount. The healthcase program protected also relatives. As a child with less than 25 years old, I got my eyes fixed.

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I forgot to say...

Such healthcare programs usually have some hundred pages handbook you'd better read. They usually state:

• what you are allowed to do and what you are not (besides ethics, the program usually specifies if you are allowed to fix problems that you have since before enrolling the program)

• which problems are covered by the program and which are not

• if you pay for the operation and then you get a reimbursement, or if the program directly pays for the operation

• which is the maximum cost the program pays for each kind of operation

• where you are allowed to have the operation. (Please also note that such a choice may alter the maximum cost the program is willing to pay for the operation)

Answer 15

You are going to pay for health care insurance all your life - why shouldn't you use it to fix a life-long problem? The fact that today's employer happens to be the co-contributor d'jour doesn't make this unethical at all.

The longer answer

Your question suggests that because the issue you want to deal with isn't work-related or hasn't been experienced predominantly during the period of current employment that it seems unfair to (metaphorically) ask your current employer to permit the operation — as if the funds they contribute give them a vote when it comes to your personal health care.

That isn't the way insurance or employer contributions to insurance works. Your employer is providing this benefit as an enticement to work for them. It is, quite literally, no different from your salary — and when looked at in that regard, your question could be rephrased as, "I want to go out on a date this weekend with someone I've known since childhood, is it ethical to use the salary I receive from my current employer to pay for it?"

How you use your insurance is between you, your doctor, and your insurance provider. Although it might not be a bad idea to thank your employer for the benefit should you use it to your advantage. Who knows? You might find that your employer is so delighted with your choice that you receive some additional benefit — like an all-expense paid junket to participate in college recruitment somewhere nice.

Answer 16

On the matter of ethics, one could pursue this problem from the lens of fixed resources. In this case, your operation would be pulling resources from the pool used to compensate all health ailments and procedures at the company to direct attention to your need.

If everyone at the company were to overextend the provided insurance, it would be likely that your company would find themselves paying more for insurance than what was expected. In this case, they would renegotiate their contract for the next year to get less liability through less coverage of employees.

So yes, ethically, you could be taking money away from someone who may need it more than you, which would not feel that great.

However, from the way you represented the question, it seems like it is a matter of self-worth and perspective. The price is non-trivial for you, but likely trivial to the company. It may be a large portion of your paycheck if you were to pay out of pocket and you may wonder if you need to work harder to compensate the added expense or burden you are imposing to the company. But the beauty of insurance is that is there for the very moment that people do fall sick and ill because that is natural in life. Sometimes, people become ill or have more illness than others. That doesn't preclude someone from insurance, but rather is the reason why insurance exists. So, get that procedure.

Answer 17

If you applied for a job at this company explicitly to gain the health benefit, and intended to move to another job after the operation then that would be unethical.

If you were the owner's nephew, and the scheme was set up with the specific rules so that you could benefit from it then that would be unethical (and back when I was a practising actuarial student, I heard of exactly such a case).

If you, by your own admission, discovered that this benefit is available for you as part of your remuneration (and, as other people have commented, make sure it does cover pre-existing conditions) then it it no more or less ethical than having a free coffee if your company offers that.

Answer 18

you work and make a profit for this company, so I see no problem using your health plan (which you worked for) to have the necessary surgery

Answer 19

Being advocatus diaboli, YES, it is unethical.

Those healthcare plans are an insurance against upcoming issues, not a catch-them-all for lifelong ones. Imagine they offered you some dental insurance and you went out next month to get 10 teeth repaired... If it's not expensive it's less unethical, but still unethical.

That being said, if they have not ruled it out, they either accept these cases (as a means to attract employees maybe) or just made a mistake.

If you are concerned, ask them!