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My employer offers health insurance through an HMO, but it's not available
to all the employees. Is that legal?
Although it might not sound fair, it is perfectly legal. Employers are
allowed to determine which classes of employees are offered a health plan.
A manufacturing plant, for instance, can choose to offer a health plan
to executive employees or managers and not to shop floor workers. However,
all of the employees in the designated class must be offered the health
plan; the employer cannot offer the health plan only to select employees
in that designated class.
In addition, once an HMO or insurance company extends an offer of coverage
to an employer, no employee in that class can be excluded from coverage
simply because he or she has health problems. The health plan can screen
the health history of the individual employees in the group, but only
to determine whether it will accept or reject the entire group for coverage
or what group premium to charge.
When it comes to small employer group coverage, many states now require
"guaranteed issue," which means an insurance company or HMO
cannot refuse to cover a group, even if one or more employees or their
dependents have health problems. The health status of the employees can
be reviewed, but only to set the premiums for the group.
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