Other Employee Right - Benefits

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.