Can My Employer Cancel My Health Insurance While On Disability

When Can My Employer Cancel My Insurance

Whether your hours have changed at work or your thinking about quitting, you may be wondering when your employer can cancel your health insurance? There are many instances when a health insurance policy can be canceled, but its important to understand when this can happen and why.

Below, well go over many instances where an employer can cancel health insurance coverage justly. Its also important to understand your responsibilities surrounding your coverage.

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What Do I Do If I Am Being Denied Leave

When you request a leave, put the request in writing, explaining the reason for leave and how long a leave you need. Keep copies of everything you send to and receive from your employer, as well as copies of doctor’s notes and any other medical documentation.

If you are denied leave, you may want to file a grievance. If you are a union member, you may be able to file a formal grievance through the union. Try to get a shop steward or other union official to help you work through the grievance process. Some employers have policies for handling a dispute regarding leaves. You may be able to resolve the dispute internally with your employer. Find out what your employer’s policies are by looking in your employee manual or other sources of personnel policies. If your company has a human resources department, they may be able to help.

However, even if you file a grievance with your employer, the deadlines to file in court or with an administrative agency still apply, so be sure not to miss them.

If The Fmla Does Not Apply Is Cobra Or A Similar State Law Triggered

COBRA gives employees and their qualified beneficiaries the opportunity to continue health insurance coverage under the companys health plan at the employees expense when a qualifying event would normally result in the loss of eligibility. Qualifying events include not only resignation and termination of employment, but also reduction of an employees hours or a leave of absence causing the employee to lose coverage under the terms of the employers health plan.

The threshold for reduced hours or absences disqualifying an employee from plan coverage depends upon the terms of the particular health insurance plan. Where the employee loses coverage under the terms of the plan, COBRA provides an opportunity for the employee to purchase continuation coverage at the employees expense. Employers with fewer than 20 full and part-time employees are not subject to federal COBRA, but may be subject to state COBRA laws for small employers.

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Shortened Periods Of Coverage

Continuation coverage generally begins on the date of the qualifying event and ends at the end of the maximum period. However, a period of coverage may end earlier if:

• an individual does not pay premiums on a timely basis.
• the employer ceases to maintain any group health plan.
• after the COBRA election, an individual obtains coverage with another employer group health plan.
• after the COBRA election, a beneficiary first becomes entitled to Medicare benefits. (However, if Medicare entitlement, either Part A or Part B, is effective on or before the date of the COBRA election, COBRA coverage may not be discontinued on account of Medicare entitlement, even if the individual enrolls in the other part of Medicare after the date of the election of COBRA coverage. Notices Required of Employers or Plans

Initial Notice: A group health plan must provide an initial notice describing COBRA rights to each covered employee and spouse of the employee at the time coverage under the plan begins. The plan may send a single notice addressed to a covered employee and the covered employee’s spouse at their joint address, provided the plan’s latest information indicates that both reside at that address. Alternatively, a plan may send separate notices to an employee and the employee’s spouse.

Can My Employer Cancel My Health Insurance While On Disability

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Establish A Formal Continuation Of Benefits Policy For Your Company

Typically, insurers wont specifically address the issue of continuation of benefits, so it is up to you as the employer to determine your own policy. As long as a disabled employee is considered to be employed, they will continue to receive coverage.

You must create a formalized Continuation of Benefits provision that lays out how your company will handle this situation for any employee that becomes disabled and receives LTD benefits. By doing this, youll know that all of your employees will be treated fairly and equally. It will also leave no doubt as to how the situation is to be approached.

Some of the questions you will need to ask yourself when creating a Continuation of Benefits provision are:

Notices Required Of Qualified Beneficiaries

An employee or qualified beneficiary must notify the plan administrator of a qualifying event within 60 days after divorce or a child’s ceasing to be covered as a dependent under the plan’s rules. Also, a qualified beneficiary must notify the plan administrator within 60 days of those events when they occur during the initial 18 or 29-month period of coverage in order to qualify for an extension of the coverage period to 36 months.

If a second qualifying event is the death of the covered employee or the covered employee becoming entitled to Medicare benefits, a group health plan may require qualified beneficiaries to notify the plan administrator within 60 days of those events, as well. Ordinarily, the employer is responsible for notifying the plan administrator of an event that is the death of a covered employee or the covered employee becoming entitled to Medicare benefits. However, if the covered employee’s employment has been terminated, the employer may not be in a position to be aware of those events. If the plan does not require qualified beneficiaries to notify the plan within 60 days of a second qualifying event that is the death of the covered employee or the covered employee becoming entitled to Medicare benefits, a qualified beneficiary should provide that notice by the later of the last day of the 18-month period or the date that is 60 days after the date of the second event.

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Can Your Employer Cancel Your Health Insurance While You Are Out On A Disability

Under the terms of the FMLA, you wont be terminated for sustaining an injury on or off the job. Further, youll be permitted to return to work in your former position once youre healthy enough to work. Your leave will be controlled and supervised by a medical professional. In other words, youll qualify for FMLA leave only if your doctor judges that your injury renders you unable to perform your job duties. Youll be able to return only if your doctor clears you to resume your former duties.

While youre on medical leave, youre protected by several important federal regulations. Under most circumstances, the Family and Medical Leave Act will protect your health insurance benefits until youre ready to return to work. Under the terms of your leave, your employer may not terminate your health insurance benefits simply because youre unable to perform your job duties. Likewise, your employer cant terminate your benefits simply because theyve become a financial burden. Events that qualify for continuing benefits under the FMLA include:

• Doctor-cleared disabilities or injuries
• A family members sudden injury or illness
• Certain other serious situations

Employers Obligation To Continue Health Insurance Coverage During Leave Or Extended Absence

When employees are absent from work for an extended period of time due to injury, illness, or other reason, a common question that arises is whether employers must continue providing health insurance during the absence. The answer depends upon the circumstances, including the reason for the employees absence, the size of the employer, the terms of the health plan, and the applicability of one or more federal laws, including FMLA and COBRA. In many cases, the issue is resolved by answering three questions:

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Health Insurance Cancellations During Disability

Can your employer cancel your health insurance while you are out on disability? The sad reality is that many people can lose their coverage when they need it the most when an accident, illness, or maternity leave prevents them from earning an income and they need access to medical care in order to recover.

The Family Medical Leave Act requires temporary group health insurance continuation for a portion of workers not all. You could easily fall into one or both of these cracks.

Can My Employer Prevent Me From Working While I’m Disabled Or Require Me To Take A Certain Amount Of Leave

Under the ADA, an employer is allowed to refuse to hire or to prevent from working any individual who poses a direct threat to the health or safety of themselves or others. A direct threat means a significant risk of substantial harm. Employers have legitimate concerns about maintaining a safe workplace for all employees and members of the public. In some instances, employers may determine that the nature of a particular person’s disability may cause an unacceptable risk of harm and therefore they may prevent that person from working or require that person to take leave until the threat of harm no longer exists.

The determination that there is a direct threat must be based on objective evidence and reasonable medical judgment regarding an individual’s current ability to perform essential functions of a job. It cannot be based on unfounded fears or generalizations. An employer cannot refuse to hire you because it would result in a slightly increased risk or because of fears that there might be a significant risk sometime in the future. The employer must also consider whether a risk can be eliminated or reduced to an acceptable level with a reasonable accommodation.

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Does My Current Health Insurance Status Affect Whether I Can Get Va Health Care Benefits

No. Whether or not you have health insurance coverage doesnt affect the VA health care benefits you can get.

Note: Its always a good idea to let your VA doctor know if youre receiving care outside VA. This helps your provider coordinate your care to help keep you safe and make sure youre getting care thats proven to work and that meets your specific needs.

More About How Va Health Care Works With Medicare And Other Insurance

This is your decision. You can save money if you drop your private health insurance, but there are risks. We encourage you to keep your insurance because:

• We dont normally provide care for Veterans family members. So, if you drop your private insurance plan, your family may not have health coverage.
• We dont know if Congress will provide enough funding in future years for us to care for all Veterans who are signed up for VA health care. If youre in one of the lower priority groups, you could lose your VA health care benefits in the future. If you dont keep your private insurance, this would leave you without health coverage.
• If you have Medicare Part B and you cancel it, you wont be able to get it back until January of the following year. You may also have to pay a penalty to get your coverage back .

Yes. We encourage you to sign up for Medicare as soon as you can. This is because:

Youll need to choose which benefits to use each time you receive care.

To use VA benefits, youll need to get care at a VA medical center or other VA location. Well also cover your care if we pre-authorize you to get services in a non-VA hospital or other care setting. Keep in mind that you may need to pay a VA copayment for non-service-connected care.

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Your Health Insurance Should Continue If You Are On Fmla Leave

The Family and Medical Leave Act permits workers to take up to 12 weeks of unpaid medical leave in a year for a serious health condition without losing their job. Whether you are eligible for FMLA leave depends on a number of factors, including the number of employees at your company, how long you have worked for the company and whether you have had other medical leaves during the past year. More information about the FMLA can be found here.

If you have health insurance with your employer and take FMLA leave, then the employer must continue your health insurance coverage on the same terms as if you had continued to work. That means, if you had made contributions to the health insurance premiums, you will continue to be obligated to do so. If premiums normally were deducted from your paycheck, but your leave is unpaid, you will have to arrange to pay the employee portion of the premiums in order to maintain coverage.

One note of caution: If you do not return to work at the end of your leave period, or if you inform your employer of your intent not to return, the employer no longer has an obligation to maintain your health insurance benefits. Additionally, the employer may require you to repay the employers share of the premium payments if you fail to return to work following leave.

Who Is Entitled To Leave Under The Law

Not all people with disabilities qualify for protection under the ADA. One criticism of the ADA is that many people fail to qualify for protection under the law for having disabilities that are either too severe, or not sever enough to warrant legal protection under the act.

According to the ADA, an individual with a disability is a person who:

• has a physical or mental impairment that substantially limits one or more major life activities
• has a record of such an impairment or
• is regarded as having such an impairment.

For more information, see our page on disability discrimination.

Also, not everyone is protected by the FMLA. Both you and your employer must meet certain qualifications.

Employer requirements: To be covered by the FMLA, your employer must have 50 or more employees on the payroll for 20 work weeks during the current or preceding calendar year. Only employees who work for your employer within a 75-mile radius of your worksite count toward the 50-employee total.

• To determine whether your employer is covered, find out how many employees are on the payroll, including those on leave and working part-time.
• If your location does not have 50 employees, find out whether your company has other employees at locations within 75 miles of where you work.

Employee requirements: To be covered by the FMLA, you must have worked for your employer for at least 12 months and for at least 1,250 hours during the last year.

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If You Are Going To Continue Benefits For Disabled Employees How Long Will You Continue Them For

If you decide you would like to continue benefits for disabled employees, you have some options for how that will work. You could:

• Continue the benefits on the same basis as if the disabled employee was an active employee.
• Provide benefits for a specific period of time .
• Provide benefits based on years of employment. You can decide on an appropriate schedule for your company. Here is an example schedule:

Determine Your Company Policy Based On Values And Capability

Your continuation of benefits policy will ultimately be determined by:

• The ongoing financial resources you are willing and able to commit to disabled employees
• Your corporate and moral responsibility to provide coverage for employees during extended periods of disability
• The result on employee morale and attitudes that a continuation of benefits policy would have

Formalizing a continuation of benefits policy may require difficult decisions, but in the end it will ensure that all employees are treated equally and fairly its essential for both the employer and employees to understand how the company will respond if an employee becomes disabled.

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Can An Employer Recover The Medical Premiums Paid For An Employee If The Employee Goes On Long

From: Benefits

From the facts presented, this employee has been on short-term disability and federal Family and Medical Leave Act leave and is now applying for long-term disability based upon her inability to return to work. The employer does not have a specific policy regarding payment of health premiums, except for the condition that the employee pays a percentage of the cost of the medical premium while out on disability. There has been no past precedent set in the handling of other leaves. The employee in question has not paid any health care premiums to date.

1. Continuing medical insurance on extended leaves. Under FMLA rules, an employer is obligated to continue medical insurance while the employee is on an approved FMLA leave for up to 12 weeks as long as the employee continues to pay his/her share of the premiums and/or makes arrangements with the employer for those premium payments.