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Understanding Your Employee Health and Disability Benefits

Do You Know the Details of Your Benefit Plans?

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Updated June 25, 2014

Employee Benefits

  • Do you have health and disability benefits from your employer?
  • Could you answer detailed questions about your health and disability benefits?

It is important for you to understand what benefits you currently have and not wait until you need to use them.

Benefit Eligibility

  • Do you need to maintain a certain number of scheduled hours to remain eligible for health and disability benefits?
  • What happens to your health and disability benefits if you switch from full-time to part-time status?

This may seem like something you don't need to worry about, but think again.

Here's an example - A person had Long-Term Disability (LTD) benefits as a full-time employee. Due to a medical condition, the person reduced their hours to part-time, intending to return to full-time status when their medical condition improved. Their condition did not improve, forcing the person to quit their job. Because they quit from a position of part-time status, they were not entitled to LTD. The person became ineligible for LTD when they went to part-time status, even though they worked many years as a full-time employee. Financially-speaking, it would have been more advantageous to quit from the position of full-time status when the LTD benefit was in effect.

  • Does your employer offer a Short-Term Disability plan (STD) or Long-Term Disability (LTD) benefit plan?
  • What is the employee contribution required for you to have STD or LTD?
  • What percentage of your pay do you continue to draw during your period of disability, and for how long?

People who work and have disabling medical conditions, such as arthritis, must be attentive to the details of their benefits. Life-changing events happen. It is important to recognize that changes you make in your employment status may have an impact on your health and disability benefits.

It's Your Responsibility

You may have many questions regarding employee benefits. The answers are your responsibility. Ask your Human Resources Manager for an Employee Benefit Handbook if you lost the one originally provided to you.

During your employment, your health plan options may change. If your health plan does change:

  • How will you and your family be affected?
  • Is your doctor still on the list of providers?
  • Has your co-pay changed?
  • Are there deductibles and limits to the coverage?

What Happens to Your Health Benefits if You Change Jobs?

HIPAA (the Health Insurance Portability and Accountability Act of 1996) is a law which can help you avoid losing benefits you already have if you move from one group plan to another. HIPAA, however, offers little protection if you are switching from a group health plan to an individual health plan, or if you have no insurance. According to HIPAA:

  • Group health plans cannot deny your application based solely on your health status.
  • If you change or lose jobs, HIPAA limits exclusions to health insurance for pre-exisiting conditions.
  • If you change or lose jobs, HIPAA guarantees the renewability and availability of health coverage to certain employees and individuals.
  • HIPAA states you cannot be denied coverage because of mental illness, genetic information, disability, or past claims.
  • HIPAA rules are applicable to all employer group health plans that have at least two participants who are current employees, including those that are self-insured. States have been given the option of applying group rules to "groups of one", helping out self-employed people.
  • Insurance portability does not ensure you will have exactly the same benefits, premiums, co-pays, or deductibles when moving from one health plan to another.
  • Most health coverage is creditable, meaning, your new health plan must give you credit for the time your were enrolled in your previous plan and deduct it from your exclusion period. (Example - if you had 12 or more months of continuous group coverage, you will have no pre-exisiting condition waiting period in your new group plan. To keep your coverage "continuous" it cannot lapse for more than 62 days.)

For More Information: Frequently Asked Questions About HIPAA

What Is COBRA? How Could It Help You?

COBRA continuation coverage gives employees and their dependents who leave an employer's group health plan the opportunity to purchase and maintain the same group health coverage for a period of time (generally, 18, 29 or 36 months) under certain conditions. COBRA can help bridge the gap. Under HIPAA rules, COBRA is counted as previous health coverage, as long as there was not a break in coverage of 63 days or more.

For More Information: Frequently Asked Questions About COBRA

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