What You Need to Know about New York Group Health Insurance Coverage
Most Americans benefit from group health insurance via their work or that of their spouse or parent. Employers purchase a group health insurance policy and offer the coverage to eligible company employees and their family members at a subsidized price. This is a common benefit of being employed by the company.
The Variety of Group Health Insurance Policies
States regulate health insurance. That means that group health insurance can differ from state to state and according to the number of employees in a company. Different rules govern group health insurance in companies with over fifty employees, and the two can charge quite different premiums. Sole proprietors who get health insurance can also differ between states.
Small Employer New York Health Insurance Coverage
Regardless of any pre-existing medical conditions, it is illegal through federal law to refuse a person group coverage. People have “guaranteed issue” from insurance companies.
However, usually, small employers’ health insurance companies may consult a person’s medical history and refuse coverage for a certain specified period, for some pre-existing conditions in an exclusionary waiting period. This period usually lasts a maximum of six months. Small group insurance companies also have to provide employees with credit for their prior coverage they have for a pre-existing condition waiting period, so long as the employer had health insurance for 63 days before they applied for a new health insurance plan.
Large Employer Group Health Insurance Coverage
Unlike small group health insurance, large employer group health insurance policies can be offered without a guaranteed-issue, so a large employer group can be turned down according to what claims the have made. However, employers can’t be singled out; if an insurance company accepts a large employer, it must insure every eligible employee and give credit for pre-existing conditions during the exclusionary period, if they had health coverage within 63 days of taking out large employer health insurance.
Can Sole Proprietors Get Group Health Insurance?
In some states, you only need an employer to qualify for group insurance, but in most cases, group health insurance is only for companies with 2 or more people employed therein. Certain states and some companies have additional rules for small employer groups so that they can prove they are legitimate businesses, and are not fraudulently claiming the number of employees.
Allowing sole proprietors to take out group coverage is termed guaranteed coverage for “business groups of one”. Some states allow this and treat this as they treat other employer groups. Some states allow this, but treat sole proprietors differently. Where sole proprietors are not allowed to take out group coverage, employers usually buy health insurance as individuals.
What are my rights if I am denied access to my employer’s group health insurance?
For many people they will lose group health insurance coverage because they change their job, divorce their spouse whose coverage they were under, or they lose their job. However, many employees do have rights to continue this coverage, under the federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). Certain states have brought in other provisions for employees not covered by COBRA.
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