In the complex landscape of health care, insurance, open enrollment, and employment, it’s difficult to know exactly what your rights are as an employee when it comes to health care. Here at Meritage Medical Network, we want you to be informed about your rights as an employee, so we have outlined some of the most important information about your rights below.
First of all, many people don’t know that most employers are not required to provide health insurance. Although more than half of the people in the U.S. are insured through their employer, only companies with more than 50 full-time employees are required to provide insurance. Based on the number of companies in the United States, it is estimated that less than 5% of organizations are actually required to provide health insurance to their employees. However, so many people in the U.S. are insured through their employer because insurance is a great incentive for hiring and keeping good workers.
Regardless of whether or not your employer is required to provide insurance, any insurance offered to employees comes with certain rights. These rights fall into many different categories:
Your employer cannot discriminate in offering health coverage based on an employee or dependent’s age, gender, race, national origin, religion, or disability. For example, an employer can’t offer someone less coverage or revoke coverage from someone because they are a certain age or because they become pregnant.
Just because employers cannot discriminate doesn’t mean that can’t offer different coverage to different employees, however. Employers do have the right to offer different categories of employees different health coverage. For example, a company may make distinctions between salaried and hourly workers, full-time and part-time workers, etc. As an employee, though, you have the right to consistent coverage that is the same as other employees within the same category as you.
Employers can choose to offer benefits only to employees, which means they are not required to offer health insurance to spouses or dependents; however, that rule must be enforced consistently, so an employer cannot offer health insurance to some employees’ dependents and not to others.
Plans offered through employers have to be operated according to certain standards, so employees and other beneficiaries must be notified of things like eligibility requirements, claim procedures, participant rights, and other changes to the insurance plan.
With the new guidelines set forth by the Patient Protection and Affordable Care Act (ACA), nearly all plans must offer what are called “essential health benefits.” These benefits include things like maternity and newborn care, emergency services, mental health and substance use disorder services, and a number of others. However, some plans created or purchased before March 23, 2010 have been grandfathered, which means that they are exempt from certain coverage and patient rights requirements such as being able to choose your own doctor and access to out-of-network emergency room services.
There are many more rights that employees have when it comes to insurance coverage through their employer. If you have questions about your plan, talk to a human resources representative and ask about your coverage and your rights. One final right that employees have is that they do not have to accept their employer’s insurance plan unless it is explicitly part of their contract.
So, if you are not satisfied with the coverage you are receiving or if you want to make changes to your plan, open enrollment is your opportunity to make a change or switch to an entirely new plan. Browse the insurance marketplace – Covered California – to see what plans are available. And make sure that Meritage Medical Network is covered by your insurance provider. We are a healthcare network of over 700 local doctors throughout Marin, Napa, and Sonoma counties providing you with the best health care possible. Make the switch to Meritage Medical Network today!