{"id":4725,"date":"2016-04-04T10:47:41","date_gmt":"2016-04-04T15:47:41","guid":{"rendered":"https:\/\/content.findlaw-admin.com\/ability-law\/smallbusiness\/employment-law-and-human-resources\/health-insurance-overview.html"},"modified":"2024-06-06T04:54:05","modified_gmt":"2024-06-06T09:54:05","slug":"health-insurance-overview","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/smallbusiness\/employment-law-and-human-resources\/health-insurance-overview.html","title":{"rendered":"Employer Health Insurance Laws"},"content":{"rendered":"\n<div class=\"fl-sectionWithSidebar fl-container fl-flex fl-flex-wrap fl-gap30  wp-container-core-columns-is-layout-9d6595d7 fl-sectionWithSidebar fl-container fl-flex fl-flex-wrap fl-gap30\">\n    \n    <div class=\"fl-section-main fl-page-articles fl-section-main fl-section-main-full-width\">\n        <h1 class=\"fl-no-margin-top\">Employer Health Insurance Laws<\/h1>\n<section class=\"fl-gutenberg-byline\">\n    <div class=\"fl-gutenberg-byline-content\">\n                    By <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/susan-buckner-j-d\/\">Susan Buckner, J.D.<\/a> | Legally reviewed by <a\n                href=\"https:\/\/www.findlaw.com\/company\/our-team\/susan-richmond-esq\/\">Susan Mills Richmond, Esq.<\/a>\n                | Last updated\n        <time>\n                            June 06, 2024\n                    <\/time>\n    <\/div>\n\n            <div class=\"fl-gutenberg-byline-editorial-note fl-text-sm\">\n            <p>Editorial Note: We earn a commission from affiliate partner links on FindLaw. Commissions do not affect the editorial integrity of our legal content.<\/p>\n\n        <\/div>\n    \n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-legally-reviewed\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Legally Reviewed\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>This article has been written and reviewed for legal accuracy, clarity, and style by <a href=\"https:\/\/www.findlaw.com\/company\/our-team.html\">FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with <a href=\"https:\/\/www.findlaw.com\/company\/company-history\/editorial-policy.html\">our editorial standards<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n\n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-fast-checked\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Fact-Checked\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>The last updated date refers to the last time this article was reviewed by FindLaw or one of our <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/contributing-authors.html\">contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please <a href=\"https:\/\/lawyers.findlaw.com\/?fli=bylinelink\" target=\"_blank\" rel=\"noopener\">contact an attorney in your area<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n<\/section>\n<p>Businesses today need ways to attract and keep employees. One way is to offer health insurance. No state or federal laws require a specific type of health insurance. Employers who provide health benefits must follow laws related to discrimination and recordkeeping.<\/p>\r\n<p>Small business owners may be caught between wanting to give their workers a health insurance plan\u00a0and premium costs a smaller company cannot afford. There are ways for small businesses to provide group health coverage for their workers while keeping costs low.<\/p>\r\n<p>This article reviews some laws employers must follow, and some health insurance options for small business owners to consider.<\/p>\r\n<p><b><i>FindLaw&#8217;s\u00a0<a href=\"https:\/\/www.findlaw.com\/smallbusiness\/employment-law-and-human-resources\/wages-and-benefits.html\">Wages and Benefits<\/a>\u00a0section has more information about health insurance and employee benefits.<\/i><\/b><\/p>\r\n<h2>The Affordable Care Act<\/h2>\r\n<p>The\u00a0<a href=\"https:\/\/www.findlaw.com\/healthcare\/patient-rights\/obamacare-small-business-compliance-with-the-affordable-care-act.html\">Affordable Care Act<\/a>\u00a0(ACA) requires employers with more than\u00a0<a href=\"https:\/\/www.healthcare.gov\/small-businesses\/learn-more\/how-aca-affects-businesses\/#:~:text=The%20Affordable%20Care%20Act%20(sometimes,dental%20coverage%20to%20their%20employees.\" target=\"_blank\" rel=\"noopener\">50 full-time employees<\/a>\u00a0to provide health insurance coverage for at least 95% of their workers. The penalties for non-compliance are severe, both in tax penalties and government-related fines.<\/p>\r\n<p>Most employers provide some type of health care for their workers if they can afford to. After wages, medical expenses are one of the main concerns for employees\u00a0in today&#8217;s job market.<\/p>\r\n<p>Small business owners with fewer than 50 employees are not required to offer health insurance, but many want to. The Small Business Health Options Program (SHOP) helps small employers enroll qualified employees in affordable health plans.\u00a0<\/p>\r\n<p>Enrollment through SHOP lets small companies qualify for the Small Business Health Care Tax Credit. This lowers premium costs and makes the insurance more affordable for the employer.<\/p>\r\n<p>Forty-six states and the District of Columbia have adopted laws like the\u00a0ACA. The laws may require health insurance for businesses smaller than those indicated by the ACA. Business owners should verify their state laws with their insurance broker or attorney.<\/p>\r\n<h2>Anti-Discrimination in Employment Health Benefits<\/h2>\r\n<p>When employers offer insurance benefits to their employees, they must follow the same\u00a0<a href=\"https:\/\/www.findlaw.com\/smallbusiness\/employment-law-and-human-resources\/employer-discrimination.html\">anti-discrimination laws<\/a>\u00a0that apply to employment. Employers may not base decisions on employees&#8217; race, religion, gender, age, or national origin.<\/p>\r\n<p>When offering health insurance policies, there are other things employers cannot do. Employers must offer the same type of plan to all employees who are eligible for coverage. Employers cannot:<\/p>\r\n<ul>\r\n<li>Refuse coverage to older workers or workers who may become pregnant<\/li>\r\n<li>Treat pregnancy-related disabilities differently from other health conditions<\/li>\r\n<li>Refuse coverage based on an actual or perceived disability or genetic information<\/li>\r\n<\/ul>\r\n<h3>Employee Health Insurance and Abortion<\/h3>\r\n<p>Since the U.S. Supreme Court&#8217;s decision in\u00a0<a href=\"https:\/\/caselaw.findlaw.com\/court\/spr-crt-us\/2176799.html\" target=\"_blank\" rel=\"noopener\"><i>Dobbs v. Jackson Women&#8217;s Health Organization<\/i>\u00a0<\/a>(2022),\u00a0<a href=\"https:\/\/www.kff.org\/womens-health-policy\/issue-brief\/interactive-how-state-policies-shape-access-to-abortion-coverage\/\" target=\"_blank\" rel=\"noopener\">state laws on what insurance companies<\/a>\u00a0can and cannot cover related to termination of pregnancy have changed.<\/p>\r\n<p>As of 2024, at least 33 states and the District of Columbia have laws restricting Medicare, Medicaid, and ACA Marketplace insurance from including abortion coverage.\u00a0<a href=\"https:\/\/www.kff.org\/womens-health-policy\/issue-brief\/interactive-how-state-policies-shape-access-to-abortion-coverage\/#:~:text=No%20Coverage%20Limitations%20(6%20states)%20%E2%80%93%20State%20does%20not%20limit%20coverage%20of%20abortion%20in%20private%20insurance%20or%20the%20state%20Marketplace%20and%20the%20state%20Medicaid%20program%20permits%20the%20use%20of%20state%20funds%20(non%2Dfederal)%20to%20pay%20for%20abortion%20in%20circumstances%20outside%20of%20those%20allowed%20by%20the%20Hyde%20Amendment.\" target=\"_blank\" rel=\"noopener\">Only six states have laws<\/a>\u00a0that specifically allow ACA Marketplace insurance providers to cover abortion-related health care costs.<\/p>\r\n<h2>COBRA Insurance Rights<\/h2>\r\n<p>The\u00a0<a href=\"https:\/\/www.findlaw.com\/employment\/wages-and-benefits\/cobra-insurance-rights.html\">Consolidated Omnibus Budget Reconciliation Act<\/a>\u00a0(COBRA) allows former employees to maintain their employer-sponsored health plan options for up to 18 months (36 months for dependents). Employees must pay the total monthly premiums to keep their plan active.<\/p>\r\n<p>Employers must offer COBRA options to all employees who quit, are laid off, or are fired for cause. COBRA applies to all businesses with 20 or more employees.<\/p>\r\n<h2>ERISA and HIPAA<\/h2>\r\n<p>Employers who offer health insurance plans must operate them according to two federal laws designed to protect employee rights. Under the\u00a0<a href=\"https:\/\/www.findlaw.com\/employment\/wages-and-benefits\/erisa-and-healthcare-plan-enforcement.html\">Employee Retirement Income Security Act (ERISA)<\/a>, employers must:<\/p>\r\n<ul>\r\n<li>Notify employees (plan participants) of eligibility requirements, changes to the plan, claim procedures, and related information<\/li>\r\n<li>Pay employee premiums and notify employees promptly if the insurer denies their claim<\/li>\r\n<\/ul>\r\n<p>The\u00a0<a href=\"https:\/\/www.findlaw.com\/healthcare\/patient-rights\/hipaa-the-health-insurance-portability-and-accountability-act.html\">Health Insurance Portability and Accountability Act<\/a>\u00a0(HIPAA) requires that employers offer group health insurance to all similarly situated\u00a0employees.<\/p>\r\n<p>HIPAA does not require employers to provide insurance to all workers. Employers may limit insurance to full-time or full-time equivalent employees. However, all employees within a classification must have the same insurance options.<\/p>\r\n<h2>Small Business Health Insurance Options<\/h2>\r\n<p>Small businesses that fall below the number of employees for the ACA mandate have other options for health care coverage. Self-employed individuals can also use these alternative methods.<\/p>\r\n<ul>\r\n<li><b>Health reimbursement arrangement<\/b>:\u00a0An HRA lets an employer set aside part of an employee&#8217;s pre-tax wages to pay for medical costs. Some HRAs, known as &quot;qualified&quot; HRAs, let the employer set aside a tax-free sum for employees&#8217; copays or private insurance premiums.<\/li>\r\n<li><b>Group coverage HRA<\/b>:\u00a0An employer can get a low-cost, high-deductible plan and create a fund for tax-free reimbursements for out-of-pocket costs and deductibles.<\/li>\r\n<li><b>Association health plans<\/b>:\u00a0With this system, several small businesses that share either location or industry can pool their resources and qualify for a larger group health insurance plan.<\/li>\r\n<li><b>Health savings account:<\/b>\u00a0An HSA is a savings account designed for use with a preferred provider organization (PPO )insurance plan. An HSA is a separate bank account that gives participants tax benefits and annual rollover protection.<\/li>\r\n<\/ul>\r\n<h2>Legal Help for Employers With\u00a0Health Benefits<\/h2>\r\n<p>Small businesses may not need to offer their workers a health benefits package. If they do, there are state and federal laws to follow. Contact an experienced\u00a0<a href=\"https:\/\/lawyers.findlaw.com\/employment\/?fli=dcta\" target=\"_blank\" rel=\"noopener\">employment attorney<\/a>\u00a0in your state to ensure you follow all regulations and give your workers the best coverage possible.<\/p>\r\n<div class=\"was-this-helpful\">\n    <div\n            class=\"was-this-helpful__question-container\"\n            aria-labelledby=\"was-this-helpful__question\"\n            role=\"group\"\n    >\n        <span\n                id=\"was-this-helpful__question\"\n                class=\"was-this-helpful__question fl-text-lg-bold\"\n        >Was this helpful?<\/span>\n        <button\n                class=\"was-this-helpful__button fl-text-sm\"\n                aria-label=\"Yes\"\n                value=\"yes\"\n        >\n            <span class=\"was-this-helpful__button-text fl-text-bold\">Yes<\/span>\n            <i class=\"was-this-helpful__button-icon\">\n                <svg width=\"22\" height=\"22\" viewBox=\"0 0 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11.8119 19.236 12.01 18.67 12H16M9.00003 14V18C9.00003 18.7956 9.3161 19.5587 9.87871 20.1213C10.4413 20.6839 11.2044 21 12 21L16 12V0.999995H4.72003C4.2377 0.994543 3.76965 1.16359 3.40212 1.47599C3.0346 1.78839 2.79235 2.22309 2.72003 2.7L1.34003 11.7C1.29652 11.9866 1.31586 12.2793 1.39669 12.5577C1.47753 12.8362 1.61793 13.0937 1.80817 13.3125C1.99842 13.5313 2.23395 13.7061 2.49846 13.8248C2.76297 13.9435 3.05012 14.0033 3.34003 14H9.00003Z\"\n                              stroke=\"#666666\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/>\n                    <\/g>\n                    <defs>\n                        <clipPath id=\"clip0_604_3423\">\n                            <rect width=\"22\" height=\"22\" fill=\"white\"\/>\n                        <\/clipPath>\n                    <\/defs>\n                <\/svg>\n            <\/i>\n        <\/button>\n    <\/div>\n    <span class=\"was-this-helpful__taken-action fl-text-sm-bold\"><\/span>\n    <div 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