Can my employer offer insurance that will not cover me?

Question

My employer changed to a health insurance that is out of state and the tell me that they will not cover any doctors in my state. They will cover prescriptions but how am i going to get a prescription without talking to a doctor. Is it legal for my employer to do this?

Answer 1

There is no law that an employer has to offer health insurance at all (with the exception of MA, I think). If an employer offers insurance, it's between the insurer and the employer as to the type of coverage offered (i.e. HMO, PPO, POS, indemnity, etc). In your case, the insurance offered to you should at least cover "out-of-network" doctors and hospitals; i.e. you can receive reimbursement for care given by providers and hospitals that don't have a participation agreement with the insurer. Such coverage will have a deductible you must first meet, then you'll have to pay co-insurance. After the insurer pays a percentage of the "allowable amount," you'll be stuck with the remainder of the bill, since the "allowable amount" is not based on the actual billed charges.

If this scenario isn't agreeable to you, you could always purchase your own policy, provided you meet insurability guidelines. Call your state's insurance commissioner's office and ask for a list of insurers offering individual policies in your state. If you suspect you're not insurable due to health, ask whether your state has a "high risk pool" and how you can get coverage through it.

One caution: generally, individual policies cost much more than group policies.

I hope this helps.

Answer 2

It is legal because they are not required to offer health insurance...that's why it's called a "benefit". If your health insurance company is a big one (like Blue Cross) they probably have doctors that are "in-network" with the blue cross in your state (example, say you live in CA but you have Blue Cross Texas....if you go to a doctor that is in-network with the Blue Cross CA company, then you are fine). I'm assuming that other big insurance companies operate the same way.

Answer 3

Many companies don't offer any coverage - unfortunately, benefits are a perk, not a requirement.