Group Coverage Through Your Job

Most people get health coverage as a benefit offered by their employer or union. This is called group coverage. It usually costs less and gives you more benefits than individual health insurance.

Topics on this page

• Your rights in a group plan
• Open enrollment
• When you reach age 65
• Self-insured plans

Your rights in a group plan

• A group plan cannot turn you down because you have a pre-existing condition.
• If your job ends or your benefits are cut, there are laws that protect your right to continue your coverage. You may be able to buy into your group plan for up to 36 months after your job ends. You have to meet the deadlines for signing up for continuation coverage.

Open enrollment

Most employers have an open enrollment period once a year. You can join a plan at this time if you didn't join when you started your job. You can add new dependents at this time. And you can change plans if your employer offers more than one plan.

When you reach age 65

Most people qualify for Medicare at age 65. You need to make some important decisions about Medicare then, even if you are still working or you have retirement benefits.

• Talk to your employer.
• Call HICAP at 1-800-434-0222 for free help.
• Check out Cal Medicare.

Self-insured plans

Some large employers have self-insured group health plans. The employer uses its own funds to pay for employees' health care.

• Employers may hire an insurance company or HMO to run the self-insured plan.
• If you belong to a self-insured plan, you do not have as many rights as members of other group health plans.
• Some of the rules for these plans are different from the rules for other group plans. Check with your employer.
• Self-insured plans are regulated by the U.S. Department of Labor, not by the State of California. The Department of Labor has an Employee Assistance Hotline: 1-866-444-3272.

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