Employee Protection under Group Health Plans in California:

If you are a small business owner interested in offering group health coverage to your employees, it is important to understand what protection your employees can expect under California law.

Here are some frequently asked questions your employees may have.

1. Does a group health plan have to give me coverage? If your employee is eligible for the group health plan, the answer is yes. However, if you have specific eligibility requirements, such as full-time status or a specific length of time spent at the company, the answer is no. Once an employee is eligible for your group health plan, they must be allowed to join.

2. Can I be denied coverage because of my current health status? No. This is usually defined by your employee's medical history, genetic information, current disability or their current medical health. Under anti-discrimination laws, an employee cannot be denied coverage because of one or more of these factors.

3. Will I be charged more because of my current health status? No. Again, under anti-discrimination laws, your employees may not be charged more for their health insurance premiums than employees without a health condition.

4. Will there be a waiting period before my coverage will start? Yes. As an employer, you have the ability to institute a waiting period for new enrollees. However, this waiting period must be the same for all of your eligible employees, regardless of their current health status.

5. Are the special opportunities where I can join a health plan if I have not already elected to do so? Yes. There is a 30 day opportunity for your eligible employees to enroll in your group health plan if a "special opportunity" event occurs. These events can be defined as the birth, adoption or placement of a child, marriage, loss of no share-of-cost Medi-Cal coverage or the loss of another type of coverage, whether through divorce, death, legal separation, termination or retirement.

6. One of my dependents is disabled. How long can they be covered under my group health policy? In California, if one of your employees has a disabled dependent, such as a child, this child will have coverage until the reach adulthood. There are however, limitations, which require that the dependent was previously disabled before the health coverage, was already covered by the health plan, and has not reached the age limit for dependent coverage.

7. Will my pre-existing condition limit my coverage under a group health plan? This will depend on your type of group health care plan. There are federal and state laws currently in place that limit the ability of an insurance company to deny or limit coverage for pre-existing conditions. This means that an insurance company can limit coverage for a specific amount of time, but must provide coverage after that time limit has passed. For example, if one of your employees has a pre-existing condition, the insurance company may place a six-month exclusion period on that employee that will limit their coverage. After that six months has elapsed, they may no longer limit coverage.

8. What is "continuous coverage?" Continuous coverage means that as long as your employee's coverage has not been interrupted by a break of more than 63 days in a row, they will still have coverage under your health plan. This includes transferring to a new job, a new policy or multiple changes of jobs.

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