Group health plans cannot deny coverage due to health issues. However, they can impose a waiting period of no more than 90 days before health coverage starts.
If I leave my employment, when is my employer allowed to take me off the group health plan?
Generally, health insurance ends either on your last day of work or the end of the month in which you last worked. Review your benefits information to find out exactly when your coverage ends or check with your employer’s human resource office.
You and your family may be protected by COBRA, a federal law that allows you to stay on an employer health plan under some circumstances.
According to federal law, how long can my family and I stay on my employer’s plan after I leave my employment?
Generally, you may stay on the plan on a self-pay basis for 18 months. You can find additional information and answers to questions about your rights under COBRA, a federal law, in the U.S. Department of Labor’s (DOL’s) COBRA publication (www.dol.gov). To order a copy, call DOL’s Publication Hotline at 866-444-3272.
My plan has denied my claim for a benefit that is mandated under Washington state law. My employer says they don’t have to comply with state law because their plan is self-funded. Is my employer correct?
Yes. If your employer self-funds the plan and contracts with an insurance company to provide administration services only, then under the Federal Employee Retirement Income Security Act (ERISA), your employer’s plan is exempt from many state requirements.
However, you have a right to appeal any decisions of the plan. Your appeal rights in your employee benefits plan are required by ERISA. Generally, you have 180 days to file an appeal about any decisions the plan administrator makes. The plan then has 60 days to respond in writing to your appeal.
For complete information about your appeal and other rights under federal employee-benefit laws, contact the Department of Labor's (www.dol.gov) local office in Seattle at 206-757-6781, or call their Publications Hotline at 866-444-3272.
I want to change jobs. Can the new employer’s plan deny me enrollment into the plan due to a pre-existing health condition?
Your employer’s group health insurance plan cannot deny you or your dependents enrollment into the plan based on medical history. You cannot lose your insurance just because you get sick. Also, insurers cannot charge you more money based on your health or past insurance claims.
Legally, what is the limit on the group insurance pre-existing condition exclusion?
Under health reform, group health plans that renew on or after Jan. 1, 2014, cannot deny you coverage due to health issues.