• You have to be eligible for the group health plan. For example, your employer may not give health benefits to all employees. Or, your employer may offer an HMO plan that you cannot join because you live outside of the plan’s service area.
• You cannot be turned away or charged more because of your health status. This protection is called nondiscrimination. Employers may refuse or restrict coverage for other reasons (such as part time employment), as long as these are unrelated to health status and applied consistently.

            Discrimination due to health status is not permitted

The Acme Company offers two different health plans.  Full-time employees are offered a high option plan that covers prescription drugs; part-time workers are offered a low option plan that does not.  This is permitted under the law.  By contrast, in a cost-cutting move, Acme restricts its high option plan to those employees who can pass a physical examination.  This is not permitted under the law.

• When you begin a new job, your employer may require a waiting period before you can sign up for health coverage. These waiting periods, however, must be applied consistently and cannot vary due to your health status.
• You must be given a special opportunity to sign up for your group health plan if certain changes happen to your family. In addition to any regular enrollment period your employer or group health plan offers, you must be offered a special, 30-day opportunity to enroll in your group health plan after certain events. You can elect coverage at this time. If your group health plan offers family coverage, your dependents can elect coverage as well. Enrollment during a special enrollment period is not considered late enrollment.

     Certain changes can trigger a special enrollment opportunity

•  
  • The birth, adoption, or placement for adoption of a child
  • Marriage
  • Loss of other coverage (for example, that you or your dependents have through yourself or another family member because of death, divorce, legal separation, termination, retirement, or reduction in hours worked)
• Under Minnesota law, newborns (including dependent grandchildren) are automatically covered under the parents’ fully insured group health plan, if the plan covers dependents. However, the insurer may withhold payment of any health benefits until premiums for the new premiums have been paid.
• Under Minnesota law, disabled adult children can remain on their parent’s fully insured group health plan after reaching the age at which dependent coverage is usually terminated, if they meet certain requirements. Your adult child must be incapable of self-sustaining employment by reason of the disability and remain dependent on you for support. Proof of incapacity must be furnished to the plan within 31 days of the child reaching the age at which dependent coverage would normally end.
• If you have to take leave from your job due to illness, the birth or adoption of a child, or to care for a seriously ill family member, you may be able to keep your group health plan for a limited time. A federal law known as a Family and Medical Leave Act (FMLA) guarantees you up to 12 weeks of job protected leave in these circumstances. If you qualify for leave under FMLA, your employer must continue your health benefits. You will have to continue paying your share of the premium.

The FMLA applies to you if you work at a company with 50 or more employees.

If you qualify for leave under FMLA, your employer must continue your health benefits. You will have to continue paying your share of the premium.

If you decide not to return to work at the end of the leave period, your employer may require you to pay back the employer’s share of the health insurance premium.  However, if you don’t return to work because of factors outside your control (such as a need to continue caring for a sick family member, or because your spouse is transferred to a job in a distant city) you will not have to repay the premium.

For more information about your rights under FMLA, contact the U.S. Department of Labor.

• If you work for a company with 21 or more employees, you may have family leave protection for the birth or adoption of a child under the Minnesota Parental Leave Act. While health insurance must be confirmed during such leave, the employer is not required to pay for coverage. For more information about the law, contact The Minnesota Department of Labor and Industry at 651-284-5005.