Based on the Employer Mandate under the Affordable Care Act (ACA), you may be eligible for an employer-based health plan depending on the number of hours you work and the size of your employer. Check with your employer’s human resources department to find out about insurance options they provide. See the questions below to determine if you qualify for employer-based or a COBRA health plan and if it is the best option for you.
Who may qualify for an employer-based health plan?
Under the Employer Mandate, employers with 50 or more full-time employees (or the part-time equivalent) are generally required to offer health plans to their full-time employees. If you are a full-time employee (work more than 30 hours per week), you should contact your employer’s human resources to find out if you are eligible to enroll in the health plan your employer offers. Part-time employee may also be eligible for an employer-based health plan.
How much does it cost for an employer-based health plan?
When you are enrolled in an employer-based health plan, your monthly premium depends on the plan your employer chooses. Typically, you will pay a share of the cost and your employer will pay the rest. You may also have cost-sharing, such as a deductible, co-insurance, and co-pays at the time that you receive services.
What services will an employer-based health plan cover?
Under the ACA, employers are required to cover a set of minimum essential health benefits, listed below. However, some employer-based plans received permission from the government to be exempt from this requirement, this is known as grandfathered status. Grandfathered plans can keep the same health plan as they had before the ACA went into effect on January 1, 2014. For a complete list of the covered benefits offered to you by your plan, you should view your plan’s contract or contact your HR department.
Essential Health Benefits:
- Free preventive care
- Inpatient care
- Outpatient services
- Maternity and Newborn Care
- Mental Health and Substance Abuse Disorders
- Emergency services
- Lab and imaging
- Prescription drugs
- Rehabilitative and habilitative services
- Wellness and chronic disease management services
How do I enroll in an employer-based health plan?
You will have the opportunity to enroll in your employer-based health plan during the open enrollment period. The open enrollment period is set by your employer. During this time, you can enroll, make changes to, or cancel your health plan. If you are not sure when is open enrollment starts, contact your HR department.
If you are outside of the open enrollment period, you may still be able to still enroll if you have a life event that qualifies you for a special enrollment period (SEP). Examples of qualifying life events include when an employee gets married or divorced, has a baby, or loses health insurance. If you need help determining whether you may qualify for an SEP, please contact CHA at 888-614-5400.
What happens if I lose my employer-based health plan?
When you lose your employer-based health plan because you lost your job or reduced your hours, you have the option of maintaining your health plan through COBRA, or the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA allows you and your family to extend your health plan for a period of time after you have lost your employer-based health insurance.
Who qualifies for COBRA?
You may qualify to keep your health plan through COBRA if you:
- Quit your job
- Lose your job
- Cut back on work hours
New York State’s mini-COBRA law provides more protections. Together, the federal and state laws cover most workers.
You can keep your COBRA health plan for up to 18 months. In New York, you may be able to keep your COBRA health plan for up to 36 months. You may be eligible for COBRA for a longer period if you become disabled.
What will it cost to keep my health plan through COBRA?
You pay 102% of the premium for the plan. This includes your share, the share your employer previously paid, and a small administrative fee. You pay the same co-pays and deductibles as before.
Before choosing to pay for COBRA, you should compare costs with health plans you can purchase through New York’s health plan marketplace, New York State of Health (NYSOH). Losing insurance under your previous plan is a qualifying life event to give you a Special Enrollment Period (SEP) to purchase a plan if you are outside the open enrollment period. If you decide to enroll in COBRA and later want to drop it, you will need to wait until the next open enrollment period or will have to have another SEP.
What services are offered under COBRA?
COBRA is a continuation of your insurance under your previous employer’s health plan, so it will provide the same benefits and services. However, employers that offer a lot of plans at different premiums must let you switch to a cheaper plan during their regular open enrollment period, which might come with more limited benefits.
How do I enroll in COBRA?
Your health plan or employer must send you a notice if you qualify for COBRA. You must sign up for COBRA within 60 days from the date you received the notice. The notice says where to send the premium and how much it will cost. Talk to your employer right away if you do not receive a COBRA election notice. If you need assistance enrolling into COBRA or want more information, please contact CHA at 888-614-5400.