Understanding the NEW Group Health plan Mandates

Group Health Plans

A group health plan is a health plan you get through your job or union, or as a retiree. It usually costs less than an individual health plan which you buy on your own.

Sign Up for a Group Health PlanImage

  • When you start a new job, ask how to sign up for the health plan, when the plan starts, and what you will pay.
  • Compare plans. Look at all the plans your employer offers. Try to find the one that has the most benefits you need.
  • Most employers have Open Enrollment in the fall of each year. Open Enrollment is when you can change your benefit choices. For example, you can change health plans if your employer offers more than one plan.
  • You can add new dependents to your health plan when you join the plan, during Open Enrollment, or when you marry, have a baby, or adopt a child.
  • You can keep your dependent children on your plan until they turn age 26. You may be able to add a domestic partner. When you add someone to your health plan, your monthly premium may go up.
  • The group health plan at your job cannot refuse to cover you if you have a pre-existing condition. (A pre-existing condition is an injury or illness that started before you joined the plan).
  • However, some plans have exclusion periods. This means that they will not pay for services for pre-existing conditions for up to 6 months. (If your group health plan has only 1-2 members, it can have an exclusion period of up to 12 months.)
  • Group plans cannot exclude services for pre-existing conditions in children under age 19.
  • They cannot exclude services for your pre-existing condition if you have not had any diagnosis or care for your condition in the last 6 months.
  • They cannot exclude services if you have had 6 months of “credible coverage”. This means that you had health insurance for 6 months and it ended 62 days or less before your new insurance starts.
  • The exclusion period must be shortened if you had credible coverage for 1 to 6 months.
    • For example, Mary had health insurance with her last job for 5 months. She got a new job within 61 days. Mary had 5 months of credible coverage. The exclusion period for her new health plan can only be one month.

Exclusion Periods for Pre-Existing Conditions

Waiting Periods

Some group health plans have “waiting periods” or “affiliation periods.” This means that there is a waiting period before your health plan starts. Ask your employer if there is a waiting period.

  • You will not pay any premium during the waiting period.
  • Under California law, the new waiting period cannot be longer than 60 days.
  • If your health plan has a waiting period, it cannot also have an exclusion period for pre-existing conditions. In other words, it can have a waiting period or an exclusion period, but not both.

Keep Your Group Health Plan

Federal COBRA and Cal-COBRA are laws that help you keep your group health plan for a certain amount of time if your job ends, your hours are cut, or you change jobs and there is a waiting period before your new health plan starts. You will have to pay the premiums yourself. But it may cost less than individual health insurance, which is insurance that you buy on your own. And the benefits may be better. If you qualify for Federal COBRA or Cal-COBRA you cannot be denied coverage because of a medical condition.

These laws also help your spouse, former spouse, or child keep health insurance after your job ends, or after divorce or your death.

Before Your Health Plan Ends

  • Get a letter from your health plan that says how long you were insured. This is called a Certificate of Creditable Coverage. You may need this letter when you get a new group health plan or apply for an individual health plan.

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