There are different types of health plans offered by employers, and it’s important to understand how they impact your health insurance rights.
Different types of employer health plans
There are two main types of health plans provided by employers: insured employer health plans and self-fund health plans.
Insured employer plans are purchased by your employer from an insurance company. The insurance company pays for and handles claims. These plans are subject to state and federal laws.
Self-funded health plans are different. Your employer pays your claims directly from their own funds. These plans only have to comply with federal laws as the Office of the Insurance Commissioner (OIC) does not regulate them.
Your appeal rights
If your employer self-funds the plan and contracts with an insurance company to provide administration services only, under the Federal Employee Retirement Income Security Act (ERISA) your employer’s plan is exempt from many state requirements.
However, you have a right to appeal any decisions of the plan. Your appeal rights in your employee benefits plan are required by ERISA. Generally, you have 180 days to file an appeal about any decisions the plan administrator makes. The plan then has 60 days to respond in writing to your appeal.
For complete information about your appeal and other rights under federal employee benefit laws, contact the Department of Labor's local office in Seattle at 206-757-6781, or call their Publications Hotline at 866-444-3272.
If your employer purchased a plan from an insurance company, learn more about your state and federal appeal rights.
Pre-existing conditions and insured employer plans
Your employer’s group health insurance plan cannot deny you or your dependent's enrollment in the plan based on medical history or health issues. You cannot lose your insurance just because you get sick. Also, insurers cannot charge you more money based on your health or past insurance claims.
Health insurance after leaving your job
Generally, health insurance ends either on your last day of work or the end of the month in which you last worked. Review your benefits information to find out exactly when your coverage ends or check with your employer’s human resource office.
You and your family may be protected by COBRA, which is a federal law that allows you to stay on an employer health plan under some circumstances for up to 18 months. The downside is that you will need to pay for the entire cost of the plan.
You can find additional information and answers to questions about your rights under COBRA in the U.S. Department of Labor’s (DOL’s) COBRA publication (PDF, 532 KB). To order a copy, call DOL’s Publication Hotline at 866-444-3272.