| Employer (Group) Insurance |
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| About Employer (Group) Insurance |
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Group health insurance is typically offered by employers. Or, if you are a member of a union, professional association, or other group, you may be able to get group coverage through that organization.
Some employers allow employees to choose between several plans, including both indemnity insurance and managed care. To learn more about the differences in these types of plans, visit types of health insurance.
Other employers offer only one plan. Some group plans offer dental and/or vision benefits as well as medical benefits. So it is important to compare plans to find the one that offers the benefits you need most.
All employers except those that self-insure are required to include certain state benefits in their plans. Click here for a list of mandated benefits in Oregon. You may have to ask if your employer self-insures because even those employers hire insurance companies to administer their plans. Also, self-insured health plans operate under federal law mandates instead of state laws.
Once you enroll in a health insurance plan, you usually cannot change to another plan until the next open enrollment, usually set once a year.
When group health insurance is an employee benefit, your employer usually pays a portion or all of the premiums. This means your costs for health insurance premiums will be lower than they would be if you paid the entire premium alone.
Your employer may or may not allow you to add dependents - a spouse and/or children - to the plan at work. Employers may pay all, part, or nothing to add dependents to your plan. If you can't get insurance for your dependents at work, you could buy an individual plan for your dependents.
When you get group insurance through membership in an organization, you usually will benefit from being a member of a large group. You may pay less for premiums than an individual would pay. However, the organization often does not pay a share of the premium, meaning you may be responsible for paying the entire premium yourself.
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| If You Leave A Job |
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If you leave a job where you have had employer-sponsored health insurance, you will want to ensure that you have continued protection against the high costs of health care. Whether you leave the job on your own or you are forced to leave, there is a federal law that may help you to maintain coverage.
COBRA/State Continuation
Under the Consolidated Omnibus Budget Reconciliation Act of 1985 or COBRA, group health plans sponsored by employers with 20 or more employees are required to offer continued coverage for you and your family for 18 months after you leave the job. In some cases, the COBRA period may be extended past 18 months. In order to continue your coverage under COBRA, you must notify your employer that you intend to do so within 60 days of losing your employer's health coverage. You also must pay the entire premium for the cost of the coverage.
If your employer has less than 20 employees, Oregon has State Continuation of Coverage, which is similar to COBRA. It allows employees to keep the employer health plan under circumstances ranging from loss of job to divorce to death of a spouse. Unlike COBRA, state continuation allows the employee to keep the employer coverage for six months or until they are eligible for other coverage (including Medicare), whichever is shorter. The coverage may include vision, dental, or prescription coverage.
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| Other Choices |
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If you cannot afford to keep your group coverage, you may be able to buy other coverage. Here are your choices:
Portability
This is a type of individual policy that may be available from the same insurance company that provided your group coverage. You must apply for portability coverage within 63 days of losing your group coverage. These plans must cover pre-existing health conditions and may be of interest to family members with medical issues.
Individual/Family Plan
These are plans you buy directly from an insurance company for you and or family members. See individual and family plan.
Short Term Insurance
These plans fill a temporary need, such as when you are between jobs or just graduated from college or are waiting to be covered under a group medical plan. They're best for healthy people because they don't cover pre-existing conditions.
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