Although there are various options for health insurance, you’re most likely going to choose to receive the health benefits offered via your employer insurance plan. Unless you’re self-employed, work part-time, are still considered a dependent, or fall under another category in which you have to seek and choose your insurance. While health insurance is a hefty topic with multiple layers being able to understand the basics makes you more informed and aware of what’s required of your employer when it comes to health coverage. Which, in turn, can help you make the best choices for your health and well-being.

Employer Insurance: What Is It?

Employer insurance is health insurance chosen and purchased by the employer and provided to their employees and eligible dependents. Typically, the employer is responsible for paying a bulk of the premium, and the employee pays a smaller portion of that premium. Furthermore, the employer can choose to offer additional types of insurance. For example, in addition to health insurance, they may provide dental, vision, worker’s compensation, malpractice, life, and disability insurance. It depends on the types of coverage the employer finds relevant to their business, company, and industry. However, health insurance is the only insurance type that large employers must provide their employees, as outlined in the Affordable Health Care Act.

Employer Insurance Eligibility Requirements

To qualify for employer-based insurance plans, you must be eligible to receive it. Generally, full-time employees who work more than thirty hours per week are eligible for group health insurance offered by their employer. If you’ve just started working with a company, there may be a 90 day waiting period before you’re eligible for health benefits. After this period, you’ll be able to enroll and receive those benefits. 

As it pertains to part-time employees, it’s up to the employer’s discretion whether they will extend health benefits to them or not. If they choose to offer health benefits to part-time workers, some general stipulations apply. These include that they work 20-29 hours weekly and not be considered seasonal workers, temp, retirees, or independent contractors. Additionally, these types of employees are rarely eligible for employer insurance plans. 

what is employer sponsored health insurance

Dependents and Domestic Partnerships

Regarding spouses and children, the Affordable Care Act requires coverage includes them via family plans. Additionally, children remain eligible for coverage until their 26th birthday. However, in the case of domestic partnerships, it’s up to the company’s discretion whether or not they will provide coverage. If they do so, they may require an affidavit to be signed stating that the relationship is long-term. The reason for this is to prevent insurance fraud committed by those that are roommates or living together. 

Employer Insurance Enrollment Period

Each business or company has an enrollment period. This open enrollment is dictated by when the current policy is up for renewal. Therefore, dates may vary, but it will generally occur every year around the same time. Additionally, during this enrollment period, you can continue with the same coverage or make adjustments as needed according to your health needs and goals. 

On the other hand, if you’re new and have gone through the 90-day waiting period, your enrollment will occur afterward. At this time, you’ll be able to choose an eligible plan and begin to receive health benefits and coverage. 

Employer Insurance Regulations

There are specific guidelines and regulations outlined by the Affordable Care Act concerning employer insurance. The employer mandate contains the rules large, and small employers must follow. Failure to comply could result in the employer paying a fee. While it would be quite exhaustive to go over every single regulation, I’ll instead highlight some of the most important key points to keep in mind. 

employer insurance types

Large Employers- (50 or More Employees)

  • Required to provide health coverage if 70% of their employees are full-time.
  • Must cover 95% of employee’s premiums.

Small Employers- (Less than 50 Employees)

  • Not required to provide health insurance
  • If they opt to provide health insurance, it must be compliant to Affordable Care Act requirements
  • If they choose to offer coverage, it must cover all essential health benefits 
  • If they decide to provide health insurance, there can be no annual or lifetime benefit maximums
  • Required to cover 50% of employee’s premiums

Large & Small Employers

  • Must provide affordable coverage that doesn’t exceed 9.78% of household income
  • Must provide a minimum value in which 60% of the covered services will be paid.
  • Can not deny coverage based on a pre-existing condition. 
  • They cannot enforce a waiting period that exceeds 90 days.

What You Should Takeaway From This

Ok, so what exactly is the point of me talking about employer insurance? And why does it matter? It matters because understanding your health coverage is going to help you speak up and advocate for your health. Let me tell you this is especially important if you have endometriosis, adenomyosis, PCOS, or infertility. You’re going to need to visit the doctor more frequently, have lab work done, receive fertility treatments, and maybe even have surgery such as a laparoscopy. So, understanding how your employer insurance plan will benefit you is major. Because healthcare is not cheap and medical debt for those of us with a chronic illness is REAL. 

So, don’t wait until you’re facing expensive medical services. Take the time to learn about what your employer’s insurance plan offers and how it benefits YOU. What are the eligibility requirements, and when can you enroll? Are they compliant with the Affordable Care Act? All of these things are important. If there’s something that you don’t understand, speak with your human relations advisor, and they will point you in the right direction. 

References

Health Coverage Guide by Small Business Majority: Eligible Employees and Dependents 

Cigna Employer Mandate

Health Insurance Org: Are employers required by the Affordable Care Act to purchase group insurance for their employees?

About the Author 

women's health and wellness bloggerHi, my name is Kathleen but you can call me Kat. I’m a health and wellness professional turned freelance writer and content creator.  You can find me on  YouTube and Instagram. If you take the opportunity to visit me on my other platforms don’t hesitate to leave a message, I would love to hear from you!

 

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