When Can Employers Deny Employees Their Health Insurance, Coverage, and Benefits?
Health insurance from an employer benefits their employees because it helps pay for their healthcare. Sometimes, employers may change their insurance and benefits, but the employees could adapt to these changes so long as they are informed about them. While some small businesses do not have to provide health insurance to their employees, large businesses with at least 50 employees must do so or they will face large penalties (“Can an employer deny an employee with health insurance?”). Sometimes, they can deny health insurance and some types of health coverage to their employees, but they also cannot deny them under certain situations.
Employers can deny health insurance and coverage to employees in different scenarios. Large businesses that do not have health insurance for their employees may deal with fines that are around “$2,000 for each employee exceeding the first 30 employees. This will happen if at least one of the employees in the business applies for (and gets) a federal government subsidy in order for him to buy health insurance” (“Can an employer deny an employee health insurance?”). Owners of these businesses can deny certain benefits to employees, depending on their “employee handbook or some other official documentation” (Munroe). They could also deny and/or limit coverage and certain benefits to employees according to how they are categorized in their business, such as full-time employees, part-time employees, salary workers, hourly workers, etc. (Marquand 2011; Munroe). Employers can also get health insurance policies that limit and exclude coverage for conditions, such as cancer, for their employees (Munroe). Regarding new employees, some businesses may not allow them to utilize their coverage during a trial period or a waiting period (Marquand 2011; Munroe). These business utilize waiting periods if they have “high employee turnover rates,” thereby avoiding situations in which they must pay for health coverage for employees that might leave their company a short time after being hired (Marquand 2011).
While employers could extend coverage to family members, they also can choose whether to offer coverage to the employees’ spouse. Employees’ children must receive coverage from employers that have at least 50 employees until the children turn 26 years old due to the Affordable Care Act (“If I have access to health insurance, can my husband’s company deny me coverage?” 2015). Some businesses may or may not elect to offer coverage to their employees’ spouse (“If I have access to health insurance, can my husband’s company deny me coverage? 2015).
Employers can deny insurance to employees and their spouse in several situations, but they have to adhere to their rules and the insurance policies’ rules for every employee (Marquand 2011; Munroe). Excluding insurance, coverage, and benefits to certain employees may be considered discrimination based on race, age, gender, etc. (Freeadvice staff; Munroe). By denying health coverage to employees without any legitimate reason, employees can sue their employers (Sherman 2018). Despite the legitimate denials, employees’ health insurance could help them pay for a variety of conditions.
I was enrolled in my husband’s insurance plan after I stopped working. I was coverd for two months & it was stopped because they changed the plan. In this plan, I was told that I needed to enroll in Medicare part B, because I had part A, when I was getting social security disability. I stopped getting disability because I went back to work and was no longer getting it.I explained this to them and also sent letters from social security & medicare. I have talked to numerous people to no avail, because they said if I was getting part A, that I should be getting B. I have not had medical insurance since November 2020 & I have hypertension & diabetes. I don’t know what to do.
Ms. Belinda, I can’t imagine how frustrating that must be for you, health is so important so I understand your situation. I wish I had a direct answer for you and am sorry as this is not our area of expertise. I hope that you get some resolution soon.