Given that most Americans have access to health insurance by employers, the chances are that you have this kind of health insurance, but do you know what are your rights?
While health insurance policies are regulated at the state level, employer-group health insurance is regulated at the federal level. There are three main federal laws that provide certain rights to all employees of a group health insurance.
Employee Retirement Income Security Act (ERISA)
Enacted in 1974, ERISA is responsible for regulating the benefits of all types, including group health insurance, retirement and pensions.
In terms of employment offered group health insurance plans, ERISA provides all employees with the right to important information about their health plans, such as the settlement plan, financial information and information on the management and operation of the plan.
Consolidated Omnibus Budget Reconciliation Act (COBRA)
Adopted in 1985, requires employers COBRA with twenty or more workers must provide "continuing coverage" for employees (or their dependents) who leave the health plan for one of the following reasons:
Dismissal (unless the employee is fired for misconduct)
A reduction in the number of hours an employee works
In both cases above, COBRA coverage can last up to eighteen months.
The death of the employee
If the employee is eligible for Medicare
If an employee leaves his or her spouse in legal terms because of separation or divorce
If a dependent child of the employee loses his eligibility
In these situations, COBRA coverage can last up to three years.
Health Insurance Portability and Accountability Act (HIPPA)
Enacted in 1996, HIPPA was designed to make it easier for people to qualify for employment-based health insurance, and to help people keep coverage during transition periods between jobs. HIPPA includes the following:
Discrimination Protection: None of the employees may be excluded from the employer, health care on the basis of their health status. If an employer offers health insurance benefits, they must offer them to all employees, regardless of their health status. This protection applies to all businesses, of all sizes, and also excludes any employer to discriminate because of his medical history and genetic information.
Pre-Existing Condition Exclusion Limits: An employer may exclude health plan, a pre-existing medical condition only if the employee has received a medical diagnosis, care, treatment or advice in this regard within six months from the date when they enrolled in the health insurance plan. This exclusion period may last up to twelve months (up to 18 months for late registration).
However, the period of exclusion can be reduced if the employee has been enrolled in any prior creditable coverage over 63 days before enrolling in the new health plan (in the sense that if credible coverage ended more than 63 days before, it does not count toward reducing the period of exclusion).
Renewal guaranteed: All coverage is guaranteed renewable for each employee, regardless of how many claims a person makes.
Dental and vision care: Note that the dental and vision plans do not have to comply with the regulations if they are offered separately from general health insurance. If dental or benefits are part of the health plan, they must comply.
While health insurance policies are regulated at the state level, employer-group health insurance is regulated at the federal level. There are three main federal laws that provide certain rights to all employees of a group health insurance.
Employee Retirement Income Security Act (ERISA)
Enacted in 1974, ERISA is responsible for regulating the benefits of all types, including group health insurance, retirement and pensions.
In terms of employment offered group health insurance plans, ERISA provides all employees with the right to important information about their health plans, such as the settlement plan, financial information and information on the management and operation of the plan.
Consolidated Omnibus Budget Reconciliation Act (COBRA)
Adopted in 1985, requires employers COBRA with twenty or more workers must provide "continuing coverage" for employees (or their dependents) who leave the health plan for one of the following reasons:
Dismissal (unless the employee is fired for misconduct)
A reduction in the number of hours an employee works
In both cases above, COBRA coverage can last up to eighteen months.
The death of the employee
If the employee is eligible for Medicare
If an employee leaves his or her spouse in legal terms because of separation or divorce
If a dependent child of the employee loses his eligibility
In these situations, COBRA coverage can last up to three years.
Health Insurance Portability and Accountability Act (HIPPA)
Enacted in 1996, HIPPA was designed to make it easier for people to qualify for employment-based health insurance, and to help people keep coverage during transition periods between jobs. HIPPA includes the following:
Discrimination Protection: None of the employees may be excluded from the employer, health care on the basis of their health status. If an employer offers health insurance benefits, they must offer them to all employees, regardless of their health status. This protection applies to all businesses, of all sizes, and also excludes any employer to discriminate because of his medical history and genetic information.
Pre-Existing Condition Exclusion Limits: An employer may exclude health plan, a pre-existing medical condition only if the employee has received a medical diagnosis, care, treatment or advice in this regard within six months from the date when they enrolled in the health insurance plan. This exclusion period may last up to twelve months (up to 18 months for late registration).
However, the period of exclusion can be reduced if the employee has been enrolled in any prior creditable coverage over 63 days before enrolling in the new health plan (in the sense that if credible coverage ended more than 63 days before, it does not count toward reducing the period of exclusion).
Renewal guaranteed: All coverage is guaranteed renewable for each employee, regardless of how many claims a person makes.
Dental and vision care: Note that the dental and vision plans do not have to comply with the regulations if they are offered separately from general health insurance. If dental or benefits are part of the health plan, they must comply.
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