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Can a Full-Time Employee Be Denied Group Insurance?

If a large employer offers group health insurance to its full-time employees, it cannot deny the opportunity to enroll in the group health insurance plan to any eligible individual employee. Large group employers are businesses that employ 51 or more people in a calendar year. Under the Health Insurance Portability and Accountability Act, employers cannot deny health insurance coverage to eligible individuals who have pre-existing health conditions.

  1. Eligible Employee Groups

    • Employers may determine which types of employees are eligible for group health insurance coverage. This allows the employer to offer health insurance coverage to some employees and not others based on their employment status. For example, employers often choose to offer group health insurance coverage to only full-time employees and not part-time or seasonal employees. Independent contractors and freelance workers are not technically employees of the company. Employers do not have to offer health insurance to these individuals even if fulfill the time requirements of a full-time employee.

    Group Denial

    • Insurance companies may choose to provide or deny health insurance coverage to an employer group. The employees who have health insurance coverage through their employers is considered collectively as an employer group. Insurance companies often base these decisions on the employer groups past insurance claims. The insurance company that provides group coverage to a company cannot choose to accept and provide coverage to some eligible employees and deny coverage to other eligible employees.

    Waiting Period

    • Many employers enforce a waiting or probationary period for new employees before they are eligible to enroll in the group health insurance plan. Waiting periods differ by employer, but usually last no longer than 90 days. Employers can deny full time employees group health insurance benefits during the probationary period. However, after the probationary period ends, the employer can no longer deny eligible employees the opportunity to enroll in the group health insurance plans.

    HIPAA

    • Group health insurance plans cannot deny health insurance to eligible employees because of pre-existing conditions, but they can enforce what they call a "look back" period for such conditions. Health insurance companies can look back for up to six months. This means that if the employee received treatment for a pre-existing condition less than six months before her new coverage begins; the insurance company can refuse to cover the cost of treatment for that specific condition for up to one year.

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