It is not mandatory for employers to provide health
insurance coverage to their employees. It is a voluntarily
decision taken on the part of the employer to provide
these benefits. If health benefits policies are established
and promised to employees, then employers are obligated
to provide them. If employers provide health benefits,
they should provide the same coverage and benefits to
all employees without discrimination.
Generally, employers have a wide variety of benefit
plans for their employees. However, when these
plans require contributions from covered employees,
they may include deductibles and co-pay provision.
Many state laws require employers offering health
benefits to provide certain minimum mandated coverage,
such as medical and surgical benefits, treatment of
alcoholism or drug abuse, mammograms, and treatment
of mental illness. It is better to check with your
state’s health commissioner to question your
employer’s health insurance plan’s minimum
mandate coverage. If employers are not offering the
requisite coverage, they might be held responsible
for medical expenses that the employee incurs as a
result. Employees can pursue their claims through
private legal action or their state’s department
of health and welfare.
Specific rules for women and old
aged employees
Women: Employers
providing health benefits should extend the same benefit
coverage to women who are absent from work because
of childbirth or disabilities related to pregnancy,
as are provided to employees for other disabilities.
Older-age employees:
Employees over the age of 65 have to be offered the
same health insurance coverage that is being offered
to younger employees and their spouses. The older
employees cannot be asked to pay more than younger
employees to participate in the program. In case of
voluntary participation, the premium charged to older
employees cannot be higher than that for younger employees.
If the employee is covered by health insurance, the
question that perturbs the employee most is, “What
will happen if I’m fired?” A federal law,
The Consolidated Omnibus Budget Reconciliation Act
(COBRA) requires employers to offer employees the
opportunity to continue health insurance once the
termination becomes effective. The termination can
be due to any reason other than gross misconduct.
However, the denial of continued insurance coverage
by the insurance administrator because of gross misconduct
is less.
COBRA
The Consolidated Omnibus Budget Reconciliation Act
(COBRA) gives workers and their families who lose
their health benefits the right to choose to continue
group health benefits provided by their group health
plan for limited periods of time, under certain circumstances
such as voluntary or involuntary job loss, reduction
in the hours worked, transition between jobs, death,
divorce, and other life events. Qualified individuals
may be required to pay the entire premium for coverage
up to 102% of the cost to the plan.
COBRA generally requires that group health plans
sponsored by employers with 20 or more employees in
the prior year offer employees and their families
the opportunity for a temporary extension of health
coverage (called continuation coverage) in certain
instances where coverage under the plan would otherwise
end.
COBRA outlines how employees and family members may
elect continuation coverage. It also requires employers
and plans to provide notice.
The coverage is not automatic. Employees should notify
the company or administrator about their desire to
be continued or elect to remain in the health benefit
plan. Employers must notify each employee and his/her
spouse of their COBRA rights as they join the insurance
plan or within 30 days. Employers have 30 days to
notify the plan administrator that an employee, dependent,
and/or spouse is no longer eligible to continue in
the group.
Premiums- Employees
electing continuation of coverage must pay the first
premium within 45 days of making the election. After
the first premium payment, the employee must pay additional
premiums within 30 days of when they are due. When
the employee decides to continue under the employer’s
(MISSING WORD), it is the employee who has to pay
the premium, not the employer. The premium can be
over $500/month for family coverage. In certain cases,
the employer may require the employee to pay up to
102% of the premium (2% is charged for administration
costs). The premium should be send to the employer,
not the insurance company. It should be send every
month; otherwise the coverage will lapse.
HIPAA Health Insurance Reform
Title I of the Health Insurance Portability and Accountability
Act of 1996 (HIPAA) protects health insurance coverage
for workers and their families when they change or
lose their jobs. Visit this site to find out about
pre-existing conditions and portability of health
insurance coverage.
The reform assures that the uninsured employee who
desires to be part of a group health insurance plan
cannot be charged higher premiums because of his/her
present or past medical record. The employee may only
be denied coverage on the basis of pre-existing conditions
for a maximum of 12 months. However, if an employee
had continuous coverage prior to beginning a new job,
and no more than 63 days had passed since the last
date of coverage, the oneyear exclusion period for
pre-existing conditions is reduced by the number of
months that the employee previously had coverage.
Many states have their own version of COBRA covering
smaller employers, and some even cover all employers
who offer group insurance to their employees.
