Most employers in the United States are not required to offer health insurance to their employees at all. Companies that do not offer this benefit may have difficulty attracting and retaining quality employees. If the company does decide to offer these benefits to their employees, it must conform to existing anti-discrimination legislation.
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A company that does elect to provide health insurance is also required to comply with the provisions of federal legislation governing the employer’s responsibility to notify employees about plan provisions. The same law requires employers to manage health benefit plan funds in a specific manner. Employers are also required to comply with the provisions of the Health Insurance Portability And Accountability Act (HIPAA).
Anti-Discrimination Laws and Health Insurance
When a company offers a health insurance plan to its employees, it cannot discriminate against certain groups of workers. It is barred from offering a lower level of health insurance coverage to older workers. Women who may become pregnant, and will need more and potentially more expensive healthcare services, cannot be given a lower level of protection under the plan. An employer health insurance plan cannot treat pregnancy-related claims for healthcare services relating to a miscarriage, abortion or recovering after childbirth cannot be treated differently from any other type of health condition.
All applicants for coverage under the plan must be treated equally. The employer cannot refuse to allow an employee to get health insurance because the employee is disabled, whether the disability is actual or perceived. The employer is also barred from refusing coverage based on the employee’s genetic information.
Employee Retirement Income Security Act
The provisions of the Employee Retirement Income Security Act (ERISA) deal with the way in which companies administer their health insurance plans. Once the health insurance plan has been set up, the employer is required to notify employees of their eligibility to participate in the plan.
The employer is also obligated to tell the plan members about the proper procedures for making a claim, as well as their rights under the plan. If changes are made to the plan, the employer is required to notify employees of them. The employee portion of the premiums collected for the health insurance plan must be managed in a manner that is in the best interests of the employees at all times.
Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act (HIPAA) limits the amount of time that a person enrolled in a group health insurance plan can be refused coverage for a pre-existing condition. A pre-existing medical condition is one what the plan member sought medical advice or treatment for in a set period before the group benefits plan took effect. Some plans go back six months for this purpose, but it may be longer depending on the plan in question.
The exclusion period for pre-existing conditions may be shortened if the individual was enrolled in an individual health insurance plan or a group benefit plan prior to applying for coverage through the employer’s health insurance plan. Benefits under Medicaid and Medicare are also included under this provision.
If an employee loses his or her job or voluntarily leaves, the employer is required to explain the employee’s right to continue participating in the group benefits plan under the Consolidated Omnibus Budget Reconciliation Act (COBRA) . This Act applies to companies employing 20 or more employees.
The former employee must notify his or her former employer of their decision to elect to take the COBRA benefits with 30 days of the change in employment status. If the individual wishes to continue participating in the employer benefit plan, he or she must pay the full amount of the premiums, including the amount the employer was contributing to the plan and any administrative fees payable.
This option may not be affordable for a person who is unemployed, but it may be viable option for a person who left a job voluntarily and is currently employed by a company that does not offer health insurance coverage. All former employees must be informed about their coverage options and the amount they will be required to pay if they elect to continue their benefits under COBRA.
Employers may not be required to offer a health benefits plan, but if they do, they must comply with applicable legislation. The laws are in effect to protect employees against discrimination and to help them continue to participate in a benefits plan if they are not longer employed by a company offering one. If you are not eligible for an employer based health care plan, or just want to compare yours to the cost of private insurance, use the free health insurance quotes tool offered on this page.
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