Is it legal (particularly, is it legal in Oklahoma) to mandate participation in employer-provided health insurance? The exception would be evidence of other coverage (spouse's plan, Medicare, Tribal insurance, Veterans insurance, etc). If it makes any difference to the answer, we do have a Sec 125 premium-only plan.

Basically we'd be saying, if you want to work here, then you have to be in our health insurance. I.e., participation would be a "condition of employment".

The reason is to reduce adverse selection. We're leaving a multi-employer association due a 37.6% increase this year and want to minimize the risk of major increases in coming years by maximizing our number of insureds.

Health insurance is not my area of expertise. But I can tell you that my employer (based in Missouri, but with officees in mulltiple states) requires us to take their insurance even if we have other coverage.

Who will be paying the premium? Is there an employee share or will the entire premum be paid by the employer?

Cost would be split between employee and employer.

Folks, participation in a Section 125 requires cash as one of the choices. Unless participation in health insurance comes at no cost to the employee (pre-tax or after-tax), it cannot be a condition of employment.

Must health insurance always be offered through a 125 plan?

So perhaps, if an employee is involuntarily put into the plan, then it would simply need to be an after-tax deduction outside the premium-only 125 plan?

Provided your payroll vendor can handle both pre-tax and after-tax employee contributions (most refuse).

(Putting on my payroll hat) You need to check state law on wage deduction authorizations. If you go aftertax, generally in most states, you would need the employee's signature to take that deduction (taking off payroll hat, changing back to HR hat). Are you truly willing to force the issue such that you would terminate over the employee's decision to not be covered under your health insurance plan? Because I suspect in every group there will be at least one. Are you ready to fight that battle?

Brainstorming idea....is your compensation structure such that you could think about changing it to where the employer pays 100% of the employee's health premium, but that their salary is lowered by this years premium amount? In essence, the take home pay would be the same, but every employee would automatically be covered under the plan?

Also you need to consider what happens if the employee refuses to fill out an enrollment form/medical questionnaire. Will you be able to take the group to underwriting without it? And again it gets back to how you will enforce it or deal with non-cooperation (especially with existing employees).