Basics of Employer Sponsored Health Coverage

In order to create a more appealing work environment, many employers add various benefits to their compensation packages. Such benefits include employer-sponsored health coverage. Generally speaking, this coverage is a group policy or plan obtained by the employer and offered to the employees after the completion of a set waiting period (typically 90 days). These plans may be fully paid by the employer, or may involve a payroll deduction whereby each participating employee contributes a set amount towards the cost of their coverage. Health plans can cover a wide array of benefits and may involve co-pays, deductibles, specified networks of physicians, primary care providers, prescription benefits, eligibility guidelines, open enrollment period dates, and various other options. Details of the plan are spelled out in a plan booklet that explains what is covered, how the plan will pay, how to handle appeals or grievances, who to call if there is a problem, the time frame of the plan year for deductible purposes, how to make changes to your enrollment level, and where to submit claims for processing and reimbursement (for example). Thanks to state continuation guidelines and the COBRA/HIPAA law, once employment terminates and/or the employee ceases to meet the “active employee” guidelines of the plan, the employee may be able to continue coverage for time frame set by law. In the event that continuation coverage is obtained, the participant then generally pays the full billed cost of the benefit plus a small administration fee.