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Employee Health Insurance

The amount of coverage under an employee health insurance plan depends on the employer, the health insurance group rates offered by the company with which the employer works, and the type of health insurance offered. Some companies pay the full premium for employee health insurance while others only pay a part of the premium and the employee pays the remainder. Types of employee medical insurance plans offered usually include one of the following:

-Health Maintenance Organizations (HMO)
-Preferred Provider Organizations (PPO)
-Point-of-Service Plan (POS)

Whether your goal is to find affordable group health insurance coverage or group coverage for a specialty situation, or you are simply beginning your process to obtain an online group health insurance quote, our resource and quote information is available fast and free to assist you.

Eligibility Facts to Consider During Your Search For The Best Group Health Insurance Rate

Although the government is not allowed to interfere with employer contracts with employees regarding health insurance, there are laws regulating health insurance companies in each state. Although state regulations vary, most include laws regarding the availability of employee health insurance offered through employers. There are no states in the US that allow employer plans to limit or deny access to employees based on medical conditions or medical history. Generally speaking, as long as the employee is eligible under employer guidelines (for example some require employees to work full-time in order to be eligible for health benefits) the employee is entitled to employee health insurance coverage under the employer health plan.

Individuals can obtain employee health insurance during the period of enrollment through his or her employer. If the individual is to have a child (or adopt), marry, or end other health benefits, then that individual generally has a set period of time (usually 30-60 days) in which to change or make changes to enrollment. This is called a special enrollment period. These are important facts to consider as you evaluate insurance quotes to determine the best group health insurance rate for your situation.

Eligibility of Covered Children Assumed When Calculating Health Insurance Group Rates

Newborns and adopted children are automatically covered under an individual’s employee health insurance plan for the first 31 days after birth or adoption. After this period the dependent must be enrolled in the health plan. Disabled children are able to remain under a parent’s employee medical insurance plan beyond the age at which most individuals cease to be considered dependents. These are factors considered when calculating health insurance group rates.

Waiting Period for Employee Health Insurance

New jobs may require a new employee to wait for a given period of time before signing up for employee health insurance. This waiting period cannot vary from person to person and must be applied consistently regardless of medical status. Health Maintenance Organizations (HMOs) may require an individual to wait for employee medical insurance during what is called an affiliation period. There is not health coverage during this period and there is no premium charge during this period. HMOs have a limit on how long to make the affiliation period before allowing an individual access to employee medical insurance.

Job Protected Leave

The Family and Medical Leave Act (FMLA) is a federal law designed to guarantee job-protected leave under certain circumstances. Under this law, individuals may be able to continue coverage under their employee health insurance for a limited time. This law guarantees up to twelve weeks of job-protected leave if the leave follows under the following circumstances:

-Leave of job due to illness
-Birth of a child
-Adoption of a child
-In order to care for a seriously ill family member

The FMLA law only applies to individuals who work for companies with over 50 employees. Under FMLA employee medical insurance continues but the employee must pay his or her share of premiums. If the individual does not return to work after the given period, he or she may have to reimburse the employer for premium coverage. However, if the leave is extended due to extenuating circumstances such as the care of a family member, than the individual is not responsible for reimbursement of the employer’s payment into the employee medical insurance plan during the specified period.

Pre-Existing Conditions

Employee health insurance plans can impose pre-existing condition periods onto policies, for periods that are determined by rules that can vary state-by-state. These periods restrict coverage for a specific period of time for medical conditions that existed prior to the beginning of policy coverage. Companies can look into an individual’s medical history to determine if a policy existed prior to coverage. A company may look back six months to a few years into an employee’s past to determine health coverage for a condition.

Typically, if there are no pre-existing conditions, an employee health insurance company can still look back up to six months prior to coverage for any condition relating to a claim that occurs within the first year of health coverage. Pre-existing conditions usually refer to any condition for which an individual received (or were recommended to receive) diagnosis, treatment, or advice during the six months prior to coverage under the employee medical insurance plan.

Group health insurance or employee health insurance plans cannot impose pre-existing conditions on pregnancy, newborns, or newly adopted children. Individual policies not involving employee group policies may differ on coverage for pregnancy and pre-existing conditions. Pre-existing condition periods are limited and usually give credit to previous continuous coverage under a different individual or employee medical insurance policy provided coverage did not break for more than two months. If a new employee health insurance policy provides greater coverage than an old one, then the new one may impose pre-existing condition periods for medical conditions that were not covered under the old policy.

Regulations That May Affect Your Online Group Health Insurance Quote

Employees of federal agencies of government agencies (including state agencies) have slightly different regulations on health insurance since their employee medical insurance is through the government. Under some circumstances, these agencies can decide on how much or how little benefits they will provide for their employees.

If an individual leaves a job or loses access to the employee health insurance program, there are regulations available to help the individual remain covered under the employee medical insurance for a limited time. There are also laws protecting individuals who lose employee medical insurance but are purchasing individual health insurance policies. Some of these protections involve:

-The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows an individual to remain under an employee health insurance plan with certain limitations and premium payments.
-State continuation coverage
-Conversion coverage
-Individual health insurance
-Coverage for individuals eligible under the Health Insurance Portability and Accountability Act (HIPAA)

Tax Credits With Employee Health Insurance

Individuals receiving benefits from the Trade Adjustment Assistance (TAA) Program may be eligible for federal income tax credit to assist with new premiums for health insurance after a loss of employee health insurance coverage. This is called the Health Coverage Tax Credit (HCTC) and covers 65% of the cost of qualified coverage. Coverage can include COBRA and medical coverage under Blue Cross and Blue Shield organizations.


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