Getting Health Insurance at Work

If your employer offers health coverage, you should check the different options for both you and your family members (dependents). Don't be afraid to ask questions. It's important to remember that employers can refuse or restrict coverage for some reasons. But, employers and health insurers cannot deny or restrict coverage because of a pre-existing health condition, such as cancer. And they cannot limit benefits for a pre-existing condition. Once you are covered by an insurance plan, they cannot refuse to cover treatment for a pre-existing condition.

What is employer-based or group health insurance?

Employer-based (work-based) health plans are set up for groups of people. Group health plans usually cover employees of the same company, and often their dependents. Some employers pay part of employee health care premiums, which are the monthly payments required to continue coverage. Unions and other organizations can also offer group health insurance to their members.

Signing up for health insurance at work

Usually, you can sign up for a health plan for yourself and your dependents when you first start a new job. After that, it’s usually possible to add yourself, a spouse, or a child to a work health insurance policy during the open enrollment period at work. Enrollment happens once a year and lasts for a week or two. If you’re not sure when this is, you can find out from your health insurance administrator at work. This person is usually in the human resources or employee benefits department.

Changes in your situation

You might also be able to sign up for coverage even when it isn’t open enrollment if you or your spouse had a change in situation (see list below) that resulted in you or a family member needing health coverage. Check with your health insurance administrator at work about your situation, and how quickly you must sign up.

Usually you can add yourself or a dependent to a workplace health insurance policy without waiting for the open enrollment period if you need insurance because any of the following occurred:

  • You got married
  • You became legally separated or got a divorce
  • You or your spouse was laid off or quit a job
  • You or your spouse retired or became disabled
  • You had a baby
  • You adopted a child
  • Your spouse lost health insurance due to change in job or no longer qualifies for insurance at work
  • Your spouse’s policy is no longer offering insurance to him or her
  • Death of your spouse resulting in loss of insurance that covered you or your child

Learn more about each health plan offered at work

Read carefully when choosing from health insurance and managed care options. There’s usually a chance to compare different types of coverage during open enrollment periods. You can also ask your health insurance administrator for the Summary of Plan Benefits (SPB) at any time. The SPB is an easy to read comparison of what each plan covers.

It’s important to know ahead of time if the plan you’re considering is one of the grandfathered plans or a self-insured plan in which coverage is limited (with things like annual caps and pre-existing condition exclusions). If either of these apply, there may be important limits on your coverage. Check with your health insurance administrator at work before you sign up. At that time, you can also ask if the health plan you’re considering is self-insured.

Plans that meet the Affordable Care Act (ACA) requirements don’t allow pre-existing condition exclusions,annual caps on amount they’ll pay, or charging you more because of your health problems.

If you or your dependent have cancer it’s especially important to choose a health insurance plan that best meets your needs, and doesn't have a cap on what will be paid. When comparing plans, consider a number of factors, including:

  • What are the total benefits covered by the plan?
  • What are all of the costs associated with the plan, including monthly premiums, deductibles, co-pays, and co-insurance?
  • Are your providers (primary care doctor, cancer doctors, facilities, and specialists) included in the network of doctors and hospitals covered by the plan?
  • What is the out-of-pocket limit for you or your family? The out-of-pocket limit typically counts the money you pay for deductibles, co-pays, and co-insurance. It often does not include out-of-network services and “non-essential” health benefits or treatments the plan doesn’t cover.
  • Does the plan cover your prescription drugs?

Should I consider an individual policy?

In general, job-based group insurance is better for most people than individual insurance. But if you learn that coverage at your job will cost you more than 9.5% of your income, you may find a better deal in your state’s health insurance Marketplace.

Can I get help with premiums on the Marketplace if I don’t sign up for insurance at my job?

Sometimes. If your income is low enough, you can qualify for help with premiums or other costs. If your individual coverage at work costs 9.5% or less of less of your household income, you can shop on the Marketplace but you won’t get help with premiums.

Can I shop the Marketplace if family or dependent health coverage costs too much at work?

Yes. Sometimes even though the employee’s individual coverage is affordable (if it meets the 9.5% cutoff noted above), family or dependent coverage is not. In this case, the employee can get his or her coverage at work, and shop on the Marketplace to try and get lower-cost coverage for the family. You will not be eligible for help with the premiums for family coverage, though.

What You Need To Know

  • You or spouse must be employed
  • Employees may be able to get dependent coverage to include a spouse and children until they turn 26
  • Employer may pay all or part of the premium; employee’s share may be deducted from pay
  • Employee must choose a plan
  • Premium costs may be high, especially for family coverage
  • If you lost insurance or there was a status change in your family (see list), you may be allowed to sign up at times other than open enrollment.
  • Some job-based plans don’t have to meet all the requirements (some might have caps, pre-existing condition exclusion periods, or other problems)
  • If the employer-based coverage you’re offered has very high premiums compared to your pay, you may still qualify to shop the Marketplace

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Along with the American Cancer Society, other sources of information and support are listed below.

US Department of Labor, Employee Benefits, Security Administration (EBSA)
Toll-free number: 1-866-444-3272
Website: www.dol.gov/ebsa

Information on employee benefit laws, including COBRA, FMLA, and HIPAA requirements of employer-based health coverage and self-insured health plans. Also has information on recent changes in health care laws. Information for military reservists who must leave their private employers for active duty can be found at: www.dol.gov/elaws/vets/userra/mainmenu.asp

State Health Care Marketplaces – US Department of Health and Human Services 
Toll-free number: 1-800-318-2596 (also in Spanish)
TTY: 1-855-889-4325
Website: www.healthcare.gov

Provides information on the new insurance law, takes you through the steps of finding insurance, and much more. If you don’t have Internet access, the phone number will connect you with your state’s marketplace.

US Department of Health & Human Services
Website: www.healthcare.gov

For the most up-to-date information on health care and insurance laws and how they affect you

National Association of Insurance Commissioners
Toll-free Number: 1-866-470-6242
Website: http://naic.org/state_web_map.htm

Offers contact information for your state insurance commission. You can contact your state insurance commission for insurance information specific to your state, or report problems with your insurance company

Patient Advocate Foundation (PAF)
Toll-free number: 1- 800-532-5274
Website: www.patientadvocate.org

Works with the patient and insurer, employer and/or creditors to resolve insurance, job retention and/or debt problems related to their diagnosis, with help from case managers, doctors, and attorneys. For cancer patients in treatment or less than 2 years out of treatment

Cancer Legal Resource Center (CLRC)
Toll-free number: 1-866-843-2572 (might need to leave a number for a call back)
Website: www.cancerlegalresources.org

Provides free legal information about laws and resources for many cancer-related issues including health insurance issues, denial of benefits, and government benefits

*Inclusion on these lists does not imply endorsement by the American Cancer Society.

Healthcare.gov. People with coverage through a job: If you have job-based insurance. Accessed at https://www.healthcare.gov/have-job-based-coverage/options/ on May 24, 2019.

US Department of Health and Human Services (USDHHS). Pre-existing conditions. Accessed at https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html on May 24, 2019.

Last Medical Review: May 13, 2019 Last Revised: May 13, 2019

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