126

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?

  • 118
    I feel the real dilemma should be about the actual health risks of having the unneeded operation VS not having it if it's not already inconveniencing you. – Gabriel C. Jan 28 at 12:48
  • 222
    Recently I found out that my company healthcare package covers the cost of the operation to fix my eyes. Why would it be unethical to use a part of the policy that is provided to you? If the company didn't want to cover employees that got such an operation, the company wouldn't have included it. – kolsyra Jan 28 at 13:36
  • 23
    Does your health plan also cover the cost of glasses? If you stay with the company long enough, getting your eyes fixed might actually be less costly than buying glasses periodically. – Todd Wilcox Jan 28 at 14:08
  • 5
    I agree 100% with motosubatsu's excellent answer, but wanted to clarify: is this procedure covered by your insurance on an elective basis? From what you've described it sounds like it does, but that's the sort of thing worth triple-checking before scheduling appointments with doctors. – Upper_Case Jan 28 at 14:45
  • 4
    Do you know for sure that using the benefit would actually cost the company more? For most companies, they have to pay the insurance cost, etc., just the same if it is used or not used... So in that case you have created a false dilemma... – user3067860 Jan 28 at 23:43

19 Answers 19

558

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.

  • 75
    In a nutshell this is the answer.HEALTHCARE is about your health and if you're paying for it, what's the problem? You earned it. You're paying for it and you want to use it. Side note here, what seems small now, but one day get bigger. Just because we have a health issue that seems inconsequential in the moment, it doesn't mean it cannot compound later on or make a future, unseen or unknowable illness more difficult. In short, always try to keep your health in check, even the little things. – ShinEmperor Jan 28 at 12:37
  • 51
    This is the simple answer. Your company plan administrators have already gone through a selection process of what procedures they will and won't cover. If the treatment you want is covered, you shouldn't feel bad for using it. – pboss3010 Jan 28 at 12:59
  • 12
    The catch of saying "you're paying for it" is that - at 1% of the OP's salary - the employer is almost certainly carrying the great majority of the plan cost. That said, I agree with this answer 100%. Who's paying for the plan isn't really the relevant things here. If an employer's plan covers something, there's implicit permission to use that coverage - either the plan is required by law to cover that thing (which would be hard to argue against in terms of ethics) or the employer has specifically chosen to allow coverage of that thing (which is even harder to argue against!). – dwizum Jan 28 at 14:00
  • 5
    Excellent answer. Unless this operation/medical condition is specifically excluded from coverage as an elective procedure, the risk of an employee needing/wanting to have the operation is already priced in to the plan premium. Further, your health insurance is part of your compensation, more similar to salary than different from it. It's not like it's a cosmetic procedure. – Upper_Case Jan 28 at 14:44
  • 11
    @dwizum The fact the company pays a (large?) part of the premium is not immediately relevant, it is a secondary benefit, in other words it is part of your salary; you have earned that. Even though you don't pay money for it, you have rendered services (your work) to get it, that is also a form of payment. – Mark Rotteveel Jan 28 at 19:09
297

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.

  • 140
    Right. Work-related health problems are covered under a different system, Workers' Compensation. Your health insurance is supposed to be used for your own personal issues. If you fall and break your leg on the loading dock, you use Workers' Comp. If you fall and break your leg in your bathtub, you use your health insurance. – Robert Columbia Jan 28 at 14:40
  • 5
    @RobertColumbia That's a really great example. I'm going to remember that one. – Steve-O Jan 28 at 14:49
  • 4
    The only problem with this answer is that flexible working hours and no dress code are not benefits. They might be considered advantages (some would consider that a baseline necessity), but it is not a benefit that you get from the company as remuneration for spending your time working for them. – AviD Jan 29 at 16:10
  • 4
    I prefer this answer to the currently accepted one. It's not just something that you might as well use because it hasn't been forbidden, it's an explicit and intentional benefit that you absolutely should use if you want to. – Matthew Read Jan 29 at 20:22
  • 2
    @AviD Very true. Employers like to act like company culture is a job benefit, but it isn't. Even more reason why they should take advantage of their healthcare benefits since it is literally part of their compensation – Kevin Wells Jan 29 at 21:29
69

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).

50

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.

  • 3
    Right. This is similar to asking whether it is ethical to donate part of your salary to a political cause that the employer disfavors. Socially awkward, perhaps, but not unethical. – Robert Columbia Jan 28 at 14:38
  • But if you use an office power outlet to charge your personal phone during work hours, I don't think anyone would call that unethical. There is a difference between using resources that have been made available to you, vs misusing resources for your own gain. Getting an operation you need is definitely a 'normal' use of your health plan, not a misuse or taking advantage. – Meg Jan 30 at 21:00
9

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.

  • 6
    Regarding your last sentence - not weird at all, during my tenure running data analytics for a third party benefits administrator I certainly saw many anecdotal cases where people chose employers because of specific (and sometimes unusual) coverage from the health plan. – dwizum Jan 28 at 13:57
  • 16
    Some people take jobs for the sole intention of earning money, which I don't see as unethical, and healthcare doesn't really seem any different. So long as the employer gets a good day's work out of the employee, I don't think it matters if they're there for money, healthcare, personal satisfaction, or just to get out of the house. For some individuals, the value of their health plan will far exceed their salary, so it doesn't seem unreasonable that healthcare would be a primary motivator for those people. – Nuclear Wang Jan 28 at 13:57
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.

  • Good point, it used to be the case you couldn't get "individual" healthcare, without an extra premium, if you had pre-existing conditions. So the OP can safely realize now this has (never?) been the case with employer based group policies, you can get them and use them for pre-existing. In essence, your employer's paying for it... – rogerdpack Jan 30 at 18:37
5

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.

  • 1
    If usage of health care is unusually high, the company might have to pay more next year, but one employee having one operation that isn't horribly expensive shouldn't make much, if any, of a difference. – David Thornley Jan 31 at 0:11
3

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.

2

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.

  • 1
    @shoover: oops. I initially placed the next paragraph "They might even have asked..." as footnote 2, but then decided it was better to place it inline. However left missed to remove the footnote marker there. I have now removed it. Thanks for noticing! – Ángel Jan 30 at 23:29
1

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.

  • Car insurance is quite different from health insurance. Few people would consider poking their eye out to have it replaced. – Dmitry Grigoryev Jan 31 at 8:07
  • @DmitryGrigoryev irrelevant. Many people are getting repairs to their cars done so as not to lose their no-claim discounts. If a similar system were in place for health insurance policies you can be sure many people would pay for small procedures out of pocket. – jwenting Jan 31 at 12:19
  • @jwenting I agree with what you said, but fail to understand how it relates to my comment. The reason for car insurance to have a no-claim discount is not because health insurance doesn't have one. It's because it's easy to abuse car insurance, while health insurance is much harder to abuse. – Dmitry Grigoryev Jan 31 at 16:03
  • @DmitryGrigoryev I agree that it is not hte same thing, but I used the comparison to clarify that insurances give you nothing. Health insurance companies might charge you more if you have known diseases or whatever. So the point was: They gift you nothing so dont gift them anything aswell – Bjoern Urban Feb 1 at 9:45
1

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.

1

* Please note that this is not an answer but an important highlight when considering life-altering corrective eye surgery. *


Please consider all of your options before electing for corrective eye surgery. One of the important things that I discovered through my research is that none of the forms of surgery actually restore your vision but instead correct it. Note that it is corrective in the same way that a pair of glasses or contacts corrects your vision; each form comes with its own unique caveats.

Side-effects related specifically to the diffident forms of surgey aside, you will be correcting your current refractive index to compensate for the error presented by your eye. What this means is that it will force your eyes to refocus such that you may be trading one pair of glasses for another.

In my case, I have extreme nearsightedness where I can only focus a few inches away from my face. Even though I can now see with glasses on, I cannot focus on anything that is too close to my eyes without discomfort. You can imagine the reverse for older people with reading glasses who you may have seen holding something farther away to be able to focus on it. This would be the same for me and means that if I were to get surgery then I would have to rely on reading glasses for distances that I can see now without them, such as reading news my phone while laying down in bed.

I would also recommend trying contact lenses if you haven't already as it is a closer analog than glasses and corrects differently. In my case, I can sit comfortably in front of a computer screen wearing my glasses but contacts alter my focus enough that it puts my screen at a point uncomfortably close to without reading glasses.

0

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.

0

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.

  • "Buying $1,000 of insurance to avoid paying $1,500 in medical bills is contrary to the whole idea of insurance" Mmm I'm not sure I agree here. For most insurance policies, it is expected that you will either pay too much (it 'the issue' does not happen) or too little. For example if I insure my house against fire, I'm either paying too much (since my house did not catch fire) or I am paying way too little (since whatever I paid does not cover rebuilding my house after it burnt to the ground). – Stijn de Witt Feb 1 at 22:58
  • You're looking at it in retrospect -- and attaching a value according to one's personal return. From that perspective, we ALL pay too much for insurance, on average, as insurers MUST collect more in premiums than they pay out in benefits or they go out of business. I repeat, "Insurance" is a concept meant to ensure that people have a way to cover unexpected costs. MOST of us will never get a return on our house insurance premiums -- and presonally, I hope I never do. I'd rather my house didn't burn down. If it does, though, I'm glad I'm insured. – Bob60506 Feb 3 at 1:07
  • I agree I'd rather not 'get my money's worth' when it comes to insurance on my house :) I guess I misunderstood what you were saying. I still don't agree it is unethical to buy 1000 worth of insurance to avoid 1500 in costs. I would say it's simply smart. Just as it is not unethical of the insurance company to seek profits insuring someone/something, I don't think it is unethical for the consumer to seek profits/financial benefit. – Stijn de Witt Feb 3 at 18:57
0

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.


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)

0

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.

0

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.

0

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.

-3

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!

  • 2
    Ethics has nothing to do with it. Either the OP has a policy which explicitly excludes coverage for pre-existing issues, or they have to be a catch-them-all. And if they are, there's no reason for the OP to refuse something they are entitled to. – Dmitry Grigoryev Jan 31 at 16:13
  • I would have to disagree. While eye surgery of this kind might be considered elective, it can also be seen as improving on the quality of life of the person and possibly even lead to greater productivity. The fact that the OP is not only considering it but asking here on SE would suggest a desire. I also feel that the tooth analogy is not a fair comparison as it is preventable maintenance (whereas an elective eye surgery is not). – Zhro Jan 31 at 17:39

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