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Factors You Should Consider Before Buying Employee Health Insurance Plan

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 Factors You Should Consider Before Buying Employee Health Insurance Plan
Factors You Should Consider Before Buying Employee Health Insurance Plan

Factors You Should Consider Before Buying Employee Health Insurance

No one can deny how important having a health insurance is for you and your loved ones. So whether you buy one individually or get it via employer hardly matters. But do consider some factors, if you're considering enrolling into employee health cover. Commonly offered plans by employers are: HMO, Heal Maintenance Organizations; POS, Point-of-Service Plans; PPO, Preferred Provider Organizations.

However, before you cheerfully enroll into an enrolling into an employee health insurance plan, do stop to consider few factors that have the power to influence your plan in a long run. These are employer's preference, kind of plans offered and group insurance rates provided by the insurance provider picked by employer etc. There still are few companies that pay full amount of premium for employee health insurance. However, most companies have left this practice and pay only some part and leave the rest for the employee to pay.

Know Eligibility Criteria before Choosing Any Group Insurance Plan

It's true that government cannot interfere with employer contracts with employees regarding health insurance; however, laws have been enacted to regulate health insurance companies in every state to protect consumer interest. Insurance regulations vary state wise but every one of them has laws on the health insurance plans offered by employers to their employees. All US states forbids employers from limiting or denying any employee health insurance based on his/her medical history or conditions. In short, as long as employee fulfills the general qualifications to become eligible under employer guidelines (that could be working as full-time employee) 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/her employer. Enrollees are also allowed to make changes in the event of having or adopting a child, getting married or end other health benefits; generally these changes can be made within set period of time (30-60 days). These are the important factors you should consider while evaluating insurance quotes to find the best group health insurance rate.

Factors to be Considered While Calculating Health Insurance Group Rates

There are factors that you should evaluate while calculating health insurance group rates. You should be aware that newborns and adopted children are automatically covered under an individual's employee health insurance plan for the first 31 days after birth/adoption. But after 31 days, dependent must be enrolled in the health plan. Though, children cease to be parents dependent after certain age, disabled children remain under a parent's employee medical insurance plan even if they crosses age limit set for dependents.

Waiting Period for Employee Health Insurance

Your new job may require you as a new employee to wait for a given period of time before you're enrolled into an employee health insurance. This type of waiting period doesn't vary person to person and is 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. During this period you get no health cover and also there's no premium. 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) allow individuals to take job-protected leave under certain circumstances. Under this law, individuals could also continue to get cover under their employee health insurance but for a limited time. This law guarantees up to twelve weeks of job-protected leave, but under the following circumstances:

  • Birth or adoption of a child
  • Taking leave due to illness
  • Taking leave to take care of seriously ill family member

But you should be aware that FMLA law applies only on companies that have over 50 employees. FMLA also states, employee medical insurance continues but the employee must pay his/her share of premiums. If the individual does not return to work after the given period, s/he could 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 isn't responsible for reimbursement of the employer's payment into the employee medical insurance plan during the specified period.

Pre-Existing Conditions

Insurers are within their right to impose pre-existing condition periods on employee health insurance, for periods that are determined by rules of the state. These periods restrict cover for specific period of time for medical conditions that existed prior to the beginning of policy coverage. During this period companies can look into an individual's medical history to determine if a policy existed prior to coverage. They can look back six months to a few years into an employee's past to determine health coverage for a condition.

Even if there's no pre-existing conditions, an employee health insurance company, still can 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.

However, 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.

Rules That May Affect Your Online Group Health Insurance Quote

Regulations on health insurance are slightly different for employees of federal agencies of government agencies (including state agencies) as medical insurance is through the government. Under certain circumstances, these agencies are allowed to decide how much or how little benefits they will provide for their employees.

For example: 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:

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

Tax Credits With Employee Health Insurance

People, who are getting benefits from the Trade Adjustment Assistance (TAA) Program, could be qualified for federal income tax credit to assist with new premiums for health insurance in the event of losing employee health insurance coverage. It's known as Health Coverage Tax Credit (HCTC) and covers 65% of the expense listed in the plan. Coverage can include COBRA and medical coverage under Blue Cross and Blue Shield organizations.

Factors You Should Consider Before Buying Employee Health Insurance Plan


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