If your employer offers health coverage, you should check out the different options for you and your family members (dependents). Don’t be afraid to ask questions. It’s important to remember that employers may deny or restrict coverage for a few reasons. But, employers and health insurers can’t deny or restrict coverage because of a pre-existing health condition, like cancer. Also, they cannot limit benefits for a pre-existing condition. Once you are covered by an insurance plan, you cannot be denied coverage for treatment for a pre-existing condition.
What is employer-sponsored health insurance or group health insurance?
Employer-funded health plans are intended to benefit groups of people. Group health plans generally cover employees in the same organization, often including their dependents. Some employers pay part of the employee’s health insurance premiums, which are the monthly payments required to continue coverage. Unions and other organizations may also offer group health insurance to their members.
How to sign up for health insurance at work
Generally, you can enroll in a health plan for yourself and your dependents when you start a new job. After this, it is often possible to add yourself, as well as your spouse or child, to the employee health insurance policy during the open enrollment period. Enrollment happens once a year and lasts between one and two weeks. If you’re not sure when the enrollment period opens, ask your workplace health insurance administrator. Typically, the person in charge of this is in the benefits administration (benefits) or human resources department.
Changes in your situation
You can also sign up for coverage even outside of open enrollment if you or your spouse had a significant event (see list below) that caused you or a family member to need health coverage. Check with your health insurance administrator at work about your situation, and ask how you can sign up quickly.
Generally, you will be able to add yourself or a dependent to an employee health insurance policy without waiting for the open enrollment period if you need coverage, as long as it is because either of the following occurred. the following events:
- Got married
- Legally became separated or divorced
- You or your spouse was fired or quit your job
- You or your spouse retired or became disabled
- The birth of a baby
- The adoption of a child
- Your spouse lost their health plan due to a job change or no longer qualifies for insurance at work
- Your spouse’s policy stopped covering him or her
- Death of your spouse resulting in loss of insurance that covered you or your child
Learn about each of the health plans offered at work
When considering health insurance and managed care options, carefully read the information provided for each option. You usually have the opportunity to compare different types of coverage during open enrollment periods. You can also request the Summary of Plan Benefits (SPB) from your health insurance administrator at any time. The SPB is an easy-to-read comparison of what each plan covers.
It’s important to know in advance whether they plan you’re considering is one of the grandfathered plans or a self-insured plan where coverage is limited (for example, with annual limits and pre-existing condition exclusions). If any of these apply, there may be important limits on your coverage. Check with the health care plan administrator at your job before making a decision. At that time, you can also ask if you are considering a self-insured health plan.
Plans that meet the requirements of the Affordable Care Act (ACA) do not allow pre-existing condition exclusions, annual limits on the amount to be covered, or being charged more because of your health problems.
If you or a dependent has cancer, it’s especially important to choose a health plan that best meets your needs, and one that doesn’t have a limit on what insurance will pay. When comparing health plans, consider several factors, including:
- What are all the benefits covered by the plan?
- What are all the costs associated with the plan, including monthly premiums, deductibles, copays, and coinsurance?
- Are your health care providers (primary care doctors, cancer doctors, health care centers, and specialists) included in the network of doctors and hospitals covered by the plan?
- What is the out-of-pocket limit for you or your family? The out-of-pocket limit typically consists of the money you pay for deductibles, copays, and coinsurance. It often doesn’t include out-of-network services or “non-essential” health benefits or treatments the plan doesn’t cover.
- Does the plan cover prescription drugs?
Should I consider an individual policy?
In general, employer-sponsored group insurance is better for most people than individual insurance. But if you know that your job insurance coverage will cost more than 9.5% of your income, you may be able to find a better deal in your state’s health insurance marketplace.
Can I get help with premiums on the Health Insurance Marketplace if I don’t sign up for my work plan?
Sometimes. You may qualify for help with premiums or other costs if your income is fairly low. If your coverage at work costs 9.5% or less of your household income, you can buy a plan on the Health Insurance Marketplace, but you won’t get help with premiums.
Can I buy a plan on the Health Insurance Marketplace if dependent or family coverage costs too much at work?
Yes. Sometimes, even though the employee’s coverage is affordable (complies with not exceeding the limit of 9.5% of your income), it may not be the case for family and dependent coverage. In this case, the employee can get her coverage at work and shop around in the health insurance marketplace to try to get low-cost coverage for the family. However, you will not be eligible for premium assistance on family coverage.
Facts you need to know
- You or your spouse must be employed
- Employees can get dependent coverage to include spouse and children until they turn 26
- The employer can pay all or part of the premium and deduct the other part from the employee’s pay
- The employee must choose a plan
- Premium costs can be high, especially for family coverage
- If you lost your insurance or there was a significant event in your family (refer to the list above), you will be allowed to enroll outside of open enrollment periods.
- Some employer-sponsored plans do not have to meet all the requirements (some may have limits, exclusion periods for pre-existing conditions, or other issues)
- If the employer-based coverage you are offered is very high in premium compared to what you are currently paying, you may still qualify to shop the health insurance marketplace.