Most people under the age of 65 have
health insurance coverage through an employer-sponsored health plan either from their own employer or through a job of a family member, such as a spouse or parent. However, not all employers offer health insurance to their employees. Generally the employer pays a portion of the premiums, and an employee’s contribution is paid on a pre-tax basis.
Protections as per Law
People in job-based group health plans are protected by Federal law.
Individuals and their family members cannot be denied eligibility for benefits or they cannot be charged more than similarÂ individuals , because of a health factor under employer based group plan.
BeforeÂ the Affordable Care Act came to be, employers could impose a pre-existing condition exclusion period for up to one year, but starting in 2014, job-based plans are not allowed to exclude coverage for pre-existing conditions.
The Affordable Care Act and employer-sponsored health plans
New benefits that relate to plans sponsored by employers are
- Cover forÂ young people: Young adultsÂ can remain on their parent’s insurance plan upto theÂ age of 26 as long as the policy covers dependents.
- Free Preventive Care: Most health plans are required to provide certain recommended health services aimed at preventing disease free of charge.
- Essential Health Benefits to be covered:Â Benefits like hospitalization, prescription drugs, preventive services, andÂ chronicÂ disease management must be covered by all new individual and small group plans starting in 2014.
- No Lifetime Financial Limits on Coverage: Health insurance plans cannot set a dollar limit on the amount the insurance company will spend on “essential health benefitsâ during the period theÂ person is enrolled in that plan.
- Summary of Benefits and Coverage: People mustÂ Â get a plain Â summary (called a Summary of Benefits and Coverage, or SBC) of a health plan’s benefits to help them better understand the plan’s coverage and compare plans. Plans must provide the SBC when a person is shopping for coverage, when there is a major change in benefits, or anytime a person asks for it.
- Â To getÂ more information on fully-insured employer-sponsored health insurance or to find out what type of coverage laws exist in your state, please contact your state’s insurance department. www.naic.org/state_web_map.htm.