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Health Insurance and Benefits: Your Rights

Employers in the United States are generally not legally obligated to offer health insurance to their employees. But lots of companies offer it anyway. Having health insurance coverage helps businesses get and keep good employees. Employee healthcare benefits also ensure greater productivity and fewer sick days.

Health benefits can include medical, disability, dental, and life insurance. When an employer offers health benefits, laws from the U.S. Department of Labor (DOL) spring into action. These laws help protect an employee's rights under their health plans.

The following article provides an overview of your rights as an employee regarding health insurance benefits.

Anti-Discrimination in Employment Health Benefits

Federally-mandated employee benefits include Social Security, Medicare, unemployment insurance, and workers' compensation. Employers aren't usually obligated to offer health benefits. But once they do, they must follow federal laws against discrimination. This means they can't treat employees unfairly based on things like gender, race, age, nationality, religion, or disability when it comes to health benefits. These laws are there to make sure everyone gets a fair deal.

As with other areas of employment, differences in health benefits coverage can't be based on an employee or dependent's gender, race, age, national origin, religion, or disability.

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 become pregnant
  • Treat pregnancy-related disabilities (including miscarriage and post-childbirth recovery) differently from other health conditions
  • Refuse to provide coverage based on an employee or dependent's actual disability

ERISA and Enforcement of Health Insurance Rights

Your employer's health plan must follow certain rules to make sure you're treated fairly. These rules are set up to protect you and other employees. They come from a law called the Employee Retirement Income Security Act of 1974 (ERISA).

Under ERISA, your employer is required to:

  1. Tell you about who can join the plan, how to make claims, what rights you have, and if there are any changes to the plan
  2. Handle and invest the plan's money wisely to benefit everyone in the plan

By following these rules, ERISA helps make sure you get the health benefits you're supposed to get.

Family and Medical Leave

Taking a leave of absence for a medical reason isn't officially a "benefit." But federal law makes sure that workers can't get fired just because they need time off for medical reasons.

The federal law that makes this happen is called the Family and Medical Leave Act (FMLA). The 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) offer partially paid leave.

Other Relevant Health Insurance Protections

Understanding your rights and protections when it comes to health insurance is crucial. Other important health insurance laws to know about include:

COBRA ensures that employees can continue health coverage after job loss. HIPPA safeguards sensitive health information and prevents discrimination based on pre-existing conditions. The ACA requires large employers to offer affordable coverage to covered employees. These laws serve to protect employees' rights and access to comprehensive health coverage, regardless of their circumstances or health status.

Health Benefits and Employee Rights: Get Legal Help

Are you an employee with questions about what you're entitled to in your job's health plan? Consider reaching out to a local employment lawyer. They can provide invaluable advice on legal matters related to employment health benefit plans. They can also help make sure that your rights are upheld and protected.

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Contact a qualified employment attorney to make sure your rights are protected.

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