Insurers use an “employee census” to obtain specific information to estimate the healthcare costs your group is likely to incur. A census does not include health status, race, religion, sexual orientation (even if applying for domestic partner benefits), Social Security number, or U.S. citizenship/immigration status.
Employee notifications / Fair Labor Standards Act
Many employers are required by the Fair Labor Standards Act (FLSA) to notify employees of coverage options available through the insurance marketplaces. These requirements generally apply to all employers with at least one employee. You can find sample disclosure notices, whether you offer insurance cover or not, on the Department of Labor’s website.
Employee Retirement Income Security Act (ERISA)
A federal law that governs many employee benefit plan aspects, including how employers must provide plan information to employees. ERISA also governs the claims and appeals procedures for qualified plans.
Employee waiting period
This is the amount of time an insured must wait before some or all of their coverage goes into effect. You may not receive benefits for claims filed during the waiting period. Waiting periods may also be known as elimination periods and qualifying periods.
Essential health benefits
The ACA requires that health insurance plans must cover at minimum the following categories of service: Ambulatory patient services, emergency services, hospitalization, pre and postnatal care, mental health, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive services and pediatric services.