CALIFORNIA
GROUP HEALTH INSURANCE PLANS AND
EMPLOYEE FAQ'S
Your Employees will have many questions regarding new hire enrollment. Here’s a FAQ list for your Employees:
Employee: Are pre-existing conditions covered on the new plan? Pre-existing conditions are covered on any Small Group health plan falling under state regulation AB 1672, or in other words ‘yes’ provided the new employee maintained continuous coverage within two months of the enrollment eligibility date. Otherwise the new health carrier can effect a 6 month pre-existing condition waiting period. If an employee terminated a health insurance plan inside of the six months immediately prior to enrollment in the health plan, the employee is given credit against the maximum of 6 months waiting period for pre-existing conditions only. A pre-existing condition is typically a medical condition a member received consultation or treatment for in the last 6 months.
Employee: Can I enroll in the health plan right away or do I have to wait? The Employer is allowed to effect one to six months waiting period from the first of the month following the date of hire. This is an Employer policy decision which per California regulations must be put into effect the same number of months for each new hire regardless of Employee position or status.
Employee: What if my spouse or child is disabled or has a serious chronic disease? Again, you and your dependents must be covered regardless of health condition once any applicable new hire waiting periods are completed, and once the 6 month pre-existing condition waiting periods have completed if employee has no current coverage.
Employee: Will I be charged more if I am unhealthy for my insurance? No, the state does not allow health history or condition as a factor for premium assignment to a single employee. The employee will pay the same rate as other employees with the same age and zip code.
Employee: What if I don’t take the insurance right now. Can I enroll any time I want later? If you miss the first initial enrollment window which is 30 days after eligibility date you can enroll in the company’s ‘open enrollment’ month which is held once a year, or you must have a ‘qualifying event’ to enroll in an off month such as termination of a group insurance plan, or other involuntary loss of other coverage through divorce, retirement etc.. Dependents can be enrolled under same qualification circumstances.
