Declining Employer's Coverage
With a health coverage system that has evolved as largely employer-based, it is often assumed that a person will naturally use their employer's coverage if it is offered. In most cases, that is true. Although an employee's share of health coverage can be high, the financial risks of being uninsured are far too great.
As the price of health coverage increases, there are a few situations that could warrant ditching your employer's coverage for something else. Keep in mind that price is just one component of the equation. Ensure that you have the access to doctors you desire and are comfortable with the administrative requirements and restrictions of a new plan prior to switching. If you have a chronic medical condition or are anticipating a major medical procedure or event, ensure your comfortable that you won't be making a mistake by changing insurance.
Your Spouse has better coverage. The major reason it might make sense for you to defer your employer's insurance in favor of other coverage is when your spouse is covered by a better plan. As a general rule, large companies and government entities have the best buying power, which translates to better coverage for lower cost. If one spouse is employed by a 20-person company, while the other works for, say, GE, the cost of adding the entire family to the GE plan may be less than attempting to carry separate company-subsidized insurance plans.
Your share of the premium clearly exceeds that of a high deductible health plan (HDHP). With competition in the marketplace for HDHP and associated HSA customers, you just may find that you can save money on premiums by taking a private policy rather than a poor policy through your employer. With an HDHP, as the name implies, comes a higher deductible, sometimes much higher. Offsetting part of the higher deductible is the possibility of saving healthcare dollars in a tax-deferred HSA, the value of which might be different for everyone. In short, if you can save a on your monthly premium by going with an HDHP, without increasing your family deductible by more than $1,000 - $1,500 per year, it is worth looking in to.
Your health coverage doesn't cover a unique need of your family. There are so many levers in a health plan - the deductible, network requirements, what is covered and what is not, how often you can seek a particular service, limitations and exclusions - that you need to review your health coverage for your unique situation. What if you require a certain medication that isn't on your health plan's formulary, or your child requires weekly therapy for which your insurance only pays 10 episodes per year? This is another case when the appeal of an HDHP / HSA combo, and the relative freedom of how you can spend that money, increases.
You have secondary coverage, which could act as a primary. While uncommon, there are some cases when a secondary payer could be an effective primary payer. The most common example would be in the case of people covered by the VA or Military Health System. While those health systems are authorized to bill a third party insurer if a patient carries it, they will also effectively cover the patient's care if they qualify. Note that the VA only acts as the primary payer for some Veterans, and doesn't cover their families.
Hybrid Approach: Ditch the Vision, and maybe the Dental. The typical vision exam costs $100 - $150, and may not be fully covered by your vision insurance. Couple that with the fact that your medical insurance would actually cover a high-cost eye injury or infection, and that doesn't leave much for your Vision plan to take care of. Make sure you aren't paying too much for it. The same goes for dental, but to a lesser extent. The frequency that one uses dental services (or at least should) is higher, and the cost of those services can pretty easily increase to the $500 - $1,000 range.