When you are on long term disability does that include health insurance?

Answer 1

Generally speaking, your health benefits through your employer will terminate after a certain period of time, even if you continue to receive Long Term Disability benefits. How long you may stay on your former employer's group health plan and who pays the premiums for that coverage depends on many factors, including the size of your employer, the state in which your employer is sitused, the state in which you work, and the state in which you live.

Generally speaking, if your employer is large enough to be subject to the Family and Medical Leave Act (FMLA) of 1993 (in other words, over 50 employees, not a church or government plan, etc.) and if you and your leave of absence meets the FMLA requirements, your health coverage will only continue until your approved FMLA leave has been exhausted (typically 12 weeks). According to the Department of Labor website:

"MAINTENANCE OF HEALTH BENEFITS

"A covered employer is required to maintain group health insurance coverage for an employee on FMLA leave whenever such insurance was provided before the leave was taken and on the same terms as if the employee had continued to work. If applicable, arrangements will need to be made for employees to pay their share of health insurance premiums while on leave. In some instances, the employer may recover premiums it paid to maintain health coverage for an employee who fails to return to work from FMLA leave."

Many states and the District of Columbia also have their own version of FMLA (sometimes called "Mini-FMLA") which expands the eligibility to smaller employers, lengthens or broadens the criteria of who is covered and when, or both. Similarly, if you belong to a collective bargaining agreement, your entitlement and access to health insurance may be contractually extended beyond the entitlements provided under FMLA or similar laws.

If your employer is smaller or is otherwise NOT subject to FMLA or similar laws, in most cases employers can and will terminate your group health insurance as an active employee as soon as you no longer meet that policy's "eligible class" definition. For example, if you are no longer working 30 hours per week on a full-time basis they may be able to terminate your coverage as of the day after your last date worked, the last day of the month, or... if it is their policy to do so... once you've used up your last date of accrued sick and/or vacation time (since some employers will consider you full time and in good standing until you've ran out of such employer-paid time off). Some employers will also extend this to the last date any Short Term Disability benefits are payable, but this depends on the employer, the state, and other factors.

It is very rare for employers to extend medical coverage beyond that which is required by law and into an extended period of Long Term Disability. When it happens it is often not in accordance with the health insurance policy's eligibility provisions. An employer, even as a result of good intentions, may be putting you at unintended risk by extending full-insured health insurance benefits to you if they do not in fact have the contractual authority to do so.

It should be noted that once your coverage as an active employee ends, this does not necessarily mean your access to health insurance has ended as well. For example, in most circumstances you should then be able to continue on the group plan on a premium-paying basis (if your employer is over 20 employees COBRA and/or State Continuation or "Mini-COBRA" for smaller employers) or else you may be able to "convert" to a free-standing individual (non-group) health insurance policy. Residents of some states and the District of Columbia have access to individual health insurance plans that do not require medical underwriting. Premiums are not always affordable to every person who is eligible to elect them.