Am I Eligible to Receive Employer Health Insurance Coverage?

Health insurance coverage is a hot-button issue for countless Americans. Given the rising costs of both premiums and medications, it’s no wonder that you’re worried about how you can afford to receive essential care. Despite the fact that coverage is more widely available, there are still many individuals who choose not to purchase these policies — often due to their perceived costs or the lack of options. In fact, 8.8% of the population, or 28.5 million people, had no health insurance coverage at any point during 2017.

However, the ability to obtain employer health insurance has made it possible for millions of Americans to afford medical care. If your job offers policy options through their own insurance company, they may bear some of the cost burdens and even allow you to access a higher tier policy than you might otherwise be able to afford on your own. But how do you know whether you’re eligible for this employer’s health insurance? And will your employer automatically offer this coverage? Here’s what you need to know.

Requirements for Businesses

There are tons of employer resources out there that will explain the regulations for insurance coverage pertaining to organizations. Since the Affordable Care Act (also known as the ACA or Obamacare) is still in place, companies must adhere to the rules outlined in this legislation as they pertain to employer-sponsored coverage.

In the majority of U.S. states, small businesses that have fewer than 50 full-time or full-time equivalent (FTE) employees do not legally have to offer health insurance. That said, many small businesses still do offer health insurance coverage to their employees, even if they are not required by law. Small businesses that opt to offer this coverage must extend this option to all full-time employees. This means that any employee who works 30 hours or more per week would be offered this option, while the business does not have to extend this option to part-time workers (who work less than 20 or 30 hours per week). However, should the business offer health insurance coverage to one part-time employee, then the business must offer this coverage to all part-time employees. Businesses with 50 or more full-time employees must offer employer health insurance coverage to all workers.

Eligibility for Employees

Now that you understand a little bit more about the rules pertaining to employer health insurance and how businesses will split the cost of premiums from insurance companies with their workers, you’ll probably want to know whether you’re eligible to receive this coverage. After all, these policies can make a huge difference for many Americans. Not every worker will be immediately eligible (or eligible at all) for employer-sponsored health insurance, though. The criteria that are usually taken into account when determining eligibility include:

  • Hours Worked: As outlined above, the number of hours you work for your employer each week will determine your insurance eligibility. Regardless of what your employee handbook says, eligible employees can work anywhere from 20 to 40 hours per week, depending on the state’s regulations. If you meet the threshold for minimum hours worked, you will be allowed to participate in group insurance coverage.
  • Waiting Periods: New hires may not immediately be deemed eligible for health insurance coverage. By law, your employer can restrict your access to group health insurance for a specific length of time; this period, however, applies to all new workers and must be determined at the time the group plan is purchased. Waiting periods may range from 30 to 180 days, depending on your employer.
  • Worker Status and Classification: In order to receive employer health insurance, a worker must be an active member of the organization. You won’t necessarily be eligible for coverage if you’re a silent partner; you need to regularly contribute to the business to qualify. In most cases, the coverage for former employees will be discontinued as soon as they depart the company. Some businesses will extend health insurance to independent contractors, provided they work the same number of hours as W2 workers. However, many businesses will use independent contractors so that they do not have to pay for health insurance benefits.

Ready to learn more about the insurance that works best for you? Contact us today for assistance.

Leave a Reply

Follow by Email