Employer Group Coverage

Many employers or employee associations offer health insurance to their employees. In fact, the Affordable Care Act requires employers with more than 50 full-time equivalent employees to offer health coverage that meets certain minimum requirements. Smaller employers may offer insurance too.

Employer-sponsored health insurance is selected and purchased by your employer and offered to eligible employees and their dependents.

Advantages of an employer plan:

• Your employer does all of the work choosing the plan options.
• Your employer often splits the cost of premiums with you.
• Your portion of the premium may be automatically deducted from your paycheck each pay period.
• Premium contributions from your employer are not subject to federal taxes, and your contributions can be made pre-tax, which lowers your taxable income.
• Your employer provides policy documents and answers questions about your plan.

Employer-sponsored health insurance is different from the kind of policy you buy with Covered California. Employer-sponsored insurance is often a group plan – a group of employees who are insured together under an employer policy. Covered California, on the other hand, sells individual insurance – a policy that you purchase just for yourself or your family.

Advantages of an individual plan:

• You can choose the insurance company, the plan and the options that meet your needs.
• You can renew or change health insurance plans, options and health insurance companies during the annual Open Enrollment period. You can also enroll or change your plan if you qualify for a special enrollment period with a qualifying life event.
• Your plan is not tied to your job, so you can change jobs without losing your coverage.
• You can choose a plan that includes the doctors and hospitals you trust.
• You may be eligible for federal or state financial help to pay for your insurance.

In most cases, if you’re eligible for employer-sponsored insurance, you aren’t eligible for financial help to buy a health plan through Covered California.