[bombcar]

Individually it usually doesn't work unless you're at a level where there is "only one of you" - think C-level exec.

But collectively it can work; the company may talk to the union and offer either X benefit which costs $Y or $Y applied to salaries.

[dmurray]

It won't save as much as you might expect, though, because the insurance provider also knows that the people opting out of the scheme would have (on average) cost the provider less to provide healthcare for.