Health Insurance and Benefits: Your Rights

Employers are generally not required by law to offer health-related benefits to their employees. Providing health-related benefits, however, is fairly common in many companies and businesses. In addition to helping employers recruit and retain top talent, employee healthcare benefits ensure greater productivity and fewer sick days.

Once an employer provides health benefits -- including medical, disability, dental, and life insurance -- federal anti-discrimination laws and health plan enforcement regulations spring into action. These laws act to protect an employee's rights under their health plans.

The following article provides an overview of your rights as an employee with regard to employer-sponsored health insurance benefits.

Anti-Discrimination in Employment Health Benefits

As mentioned above, most employers are not required to provide their employees with medical, disability, dental, or life insurance. Once such benefits are offered, the law requires the employer to adhere to federal laws prohibiting discrimination in employment.

As with other areas of employment like hiring, promotion, and termination, distinctions in health benefits coverage cannot be made based on an employee or dependent's gender, race, age, national origin, religion, or disability.

As examples, an employer providing employees with health insurance may not, among other things:

• Provide lesser coverage or cease offering coverage to older workers, or workers who may become pregnant
• Treat pregnancy-related disabilities (including miscarriage and post-childbirth recovery) different from other health conditions
• Refuse to provide coverage based on an employee or dependent's actual disability, a perceived disability, or his or her genetic information

ERISA and Enforcement of Health Insurance Rights

An employer's health plan must comply with certain standards designed to protect the interests of employees and other plan beneficiaries (such as family members). This is granted by a federal law known as the Employee Retirement Income Security Act (ERISA).

Under ERISA, employers are required to take certain steps in connection with employee health benefit plans, including:

• Notifying employees (called "plan participants") of plan eligibility standards, claim procedures, participant rights, and related changes to the plan; and
• Managing and investing plan funds according to the best interests of plan participants.

Family and Medical Leave

Taking a leave of absence for a medical reason is not officially a "benefit." Still, federal law protects workers from being terminated or otherwise treated adversely when taking protected leave.

The federal Family and Medical Leave Act (FMLA) applies to employers with at least 50 employees. Eligible employees are those who have worked with the same employer for at least 12 months and 1,250 hours.

Keep in mind that the federal law doesn't require the medical leave to be paid. Generally, the law provides unpaid medical leave without someone risking the loss of their job. Some states (including California and New York) do go so far as to offer partially paid leave.

Health Benefits and Employee Rights: Get Legal Help

Are you an employee with questions about your rights under an employment health plan? Maybe you believe your employer is violating ERISA or FMLA laws. Speak with a local employment lawyer in order to more clearly understand your rights.