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Compliance Assistance Resources

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- Health Benefits Advisor

First Job/Re-entering Workforce

A first job or re-entry into the workforce may provide opportunities for obtaining or changing health coverage. Knowing your options and understanding your rights can help you obtain the coverage that you need.

When starting a job, you should carefully consider all of the health coverage choices that may be available. You may already have health coverage, but other options may be a better choice for you and your family. In particular, you might wish to consider any group health plan offered by your new employer, employee organization (such as a union), or both, because health benefits offered through a job often provide better coverage at lower cost than other options. For information about a particular group health plan, review the plan's SPD (summary plan description).

You may also be able to buy health coverage unrelated to a job. Coverage may be available from an insurance company, an HMO (health maintenance organization) or through your membership in a student, professional or other type of association (such as AARP). Generally, your state insurance department regulates the kinds of coverage offered, the cost of the coverage and the terms and conditions of the coverage.

In addition, even though you are starting to work, you may be eligible for Medicaid, a government-sponsored health program for low-income and individuals with special needs and their families, or for SCHIP (State Children's Health Insurance Program), a government-sponsored health insurance program for qualified families.

Finally, if you meet certain requirements, you might be an eligible individual (also known as "Federally eligible" or eligible under the Health Insurance Portability and Accountability Act (HIPAA)) with guaranteed access to insurance with special protections in your state. Depending on the state, this coverage may be offered through an insurance company (including an HMO) or a state high-risk pool. For more information about eligible individuals, see Questions and Answers: Recent Changes in Health Care Law. For information about coverage available to eligible individuals in your state, contact your state insurance department .

How to Choose Among Health Coverage Options

In choosing among the options available to you, you should review the SPD for each available group health plan to determine which plan best meets your needs. You should also review and compare the information on the other coverages for which you are eligible. In making your decision, you may want to consider such things as:

  1. Any waiting period (or affiliation period) imposed under the plans;
  2. Types of benefits offered (Is dependent coverage available? Do the benefits cover your family's medical needs?);
  3. Cost of coverage (premiums, co-payments and deductibles for prescription drugs and doctor visits);
  4. Limitations on coverage (annual or lifetime dollar limits, visit limits, pre-existing condition exclusion periods, prescription drug coverage limits or limits on the availability of doctors and hospitals); and
  5. Any exclusions from coverage (treatments, procedures, conditions or prescription drugs).

IMPORTANT: Whatever health coverage you choose, and whenever you change your coverage, you should try to avoid incurring a significant break in coverage, especially if you or a family member has a pre-existing condition. A significant break in coverage is a period of 63 consecutive days (or longer in some states) without health coverage. Depending on the circumstances, avoiding a significant break in coverage may enable you and your family to shorten or eliminate any pre-existing condition exclusion period or to qualify as an eligible individual for guaranteed access to insurance with special protections (mentioned above).