Can my employer change our health insurance carrier and level of benefits during the year?
Yes. It is completely up to the employer whether or not they will offer health insurance to employees at all and they can change carriers and level of benefits at any time.
What happens when my group health coverage ends?
You can apply for individual health coverage under the federal law Health Insurance Portability and Accountability Act (HIPAA). This type of policy is issued on a guaranteed issue basis if you meet the qualifying criteria. However, there is no limit on the maximum premium the company can charge. Care for preexisting conditions may not be excluded from coverage.
What happens to my group health coverage if I leave my employer?
You may be eligible for protection under the Consolidated Omnibus Budget Reconciliation Act (COBRA) law and entitled to a minimum of 18 months of continuation coverage. You can find out more about COBRA continuation of group health benefits from the Federal Department of Labor Office of Employee Benefits Security Administration website.
Can health insurance companies deny my application for individual insurance due to a health condition?
Yes, the company has the right to deny coverage for almost any reason on a new application. However, once you are accepted for coverage the company cannot cancel your policy except for nonpayment of premium.
What is a preexisting condition?
This is normally a physical or mental condition for which medical advice, diagnosis, care or treatment is recommended or received before the effective date of the policy.
Is there assistance available?
There are many programs available through the federal or state government to assist with the high cost of health care and health insurance. You should contact your State government to learn about your elibility for Medicaid (for low-income and disabled persons), the State Children’s Health Insurance Program (SCHIP), high-risk pool coverage for invidiuals who are denied coverage, prescription drug assistance programs, or other assistance.
You should contact the Department of Health and Human Services for information about Medicare (including the new prescription drug program which provides many subsidies). In addition, the federal governement provides tax credits for certain workers who have lost their job because of federal trade agreements or whose pension program has failed.
What is a “self-insured” plan?
An employer may choose to “self-insure” by paying out benefits from its own funds. Typically, an insurance company is used to administer the program, but the liability for paying for the care of the workers rests on the employer. It is important for workers to understand that if their employer “self-insures” state patient protections (such as, access to internal and external appeals processes, assurance of certain benefits, and the right have grievances heard by the State insurance department) do not apply. All federal protections (i.e., HIPAA and COBRA) do remain.
Where can I go for help?
If you have any questions about your policy, your rights and protections, or a potential agent or insurer, you can contact the your state insurance department for information. You can also contact your state insurance department for assistance if you have a grievance against a licensed health insurer.