Many large employers (more than 50 employees) offer health insurance to their employees. The requirements and benefits are different depending on if your plan is grandfathered or non-grandfathered. If you’re not sure, ask your insurance company or your human resource department.
Large employer health insurance and health reform
As of 2015, large employers must offer affordable insurance to their employees and their dependent children. A plan's considered unaffordable if the employee’s share is more than 9.55 percent of their household income or if the plan pays for less than 60 percent of covered health care expenses.
If your employer offers health insurance, and it's not affordable, you might qualify for a premium subsidy, if you buy a health plan through Washington state’s health insurance exchange (www.wahealthplanfinder.org).
Health reform does not require large employer plans to include the essential health benefits (EHB). However, if the plan does include an EHB, then that benefit has no annual or lifetime dollar limit. See the new reforms and how they apply:
|Large employer health plan requirements under health reform||Non-grandfathered group plans||Grandfathered group plans|
|Provide you with a “Summary of Benefits and Coverage” (SBC)||Yes||Yes|
|Cannot retroactively cancel your coverage if you made a mistake on your initial application, unless the plan finds fraud or intentional misrepresentation||Yes||Yes|
|Provide health coverage for dependent children until they turn age 26||Yes||Yes|
|Provide coverage for pre-existing conditions for all enrollees||Yes||Yes|
|Allow discounts and rewards on wellness programs of up to 30 percent on premiums||Yes||Yes|
|Renew your policy even if you become sick||Yes||Yes|
|Guarantee your right to appeal eligibility and claim denials to independent review organizations (IROs)||Yes||Fully funded plan = Yes|
Self-funded plan = No
|Cover certain recommended preventive care for free||Yes||No|
|Provide you the right to choose your doctor and access to out-of-network emergency room services||Yes||Fully funded plan = Yes|
Self-funded plan = No
|May require a waiting period of no more than 90 days before you can enroll in the company's health plan||Yes||Yes|