Healthy Access Database

Employer-Based Health Insurance Coverage

The majority of Americans have group health insurance coverage through either their employer, or the employer of a family member. This section is designed for consumers who need more information about what requirements apply to group health insurance coverage, or need to know what their options are if they are about to lose access to their group coverage. It also provides contact information for the state and federal regulators who oversee private group health insurance in America, in case consumers have questions or need to report a problem. Consumers who are looking to purchase a group health insurance product can go to NAHU's Find An Agent feature to find an NAHU member in their area to assist them in obtaining coverage.

Small Employer Groups
Millions of Americans work for small employers, which for health plan purposes, are generally those with 50 employees or less. This section outlines, for each state, the state and federal requirements for small employer health plans, such as group size, the guaranteed issuance of coverage, how carriers may treat employee's pre-existing conditions, credit towards pre-existing conditions required to be given for an enrollee's prior coverage, and how the underwriting may be done to determine rates for these policies.

Large Employer Groups
Millions of Americans also get their health employer-sponsored health insurance coverage through large corporations. The requirements for the issuance of coverage to large groups are different than for small groups, and the way that rates are determined is also different. This section covers what is compulsory for large groups, on a state-by-state basis.

Continuation of Coverage Options
This section provides information about health coverage continuation options for people who lose their group health insurance coverage, due to a job change, a divorce, job loss or other reason. This includes information about COBRA benefits, state continuation of coverage options for people who are not covered by COBRA, and federally mandated group-to-individual health insurance portability benefits.

Contact Information for the Regulators of Fully-Insured Group Health Plans
Many employer-based health insurance plans are fully insured by a health insurance carrier. The individual states regulate these plans, and consumers should contact their state regulator if they have a problem with their coverage. If you are not sure whether or not your group health plan is fully-insured or not, please contact your health plan sponsor.

Contact Information for the Regulator of Self-Funded Group Health Plans or ERISA Plans
Larger group health plans (usually several hundred employees or larger) may choose to either fully or partially self-insure their group benefit plans. If your group health insurance plan is self-funded, it is regulated by the federal Department of Labor. If you are not sure whether or not your employer-sponsored health plan is self-funded or not, please contact your plan's sponsor.

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