E. Health Benefits

Only a few states require employers to provide workers with health care insurance. However, when health insurance coverage is voluntarily provided, employers may not discriminate; they must offer the same coverage to all employees regardless of sex, age, or disability. For example, if health insurance benefits are provided to the spouses of male workers, the same coverage must be provided to the spouses of female workers and the extent of the coverage provided for dependents must be equal.

The law demands equality in health coverage for pregnant workers. Most state laws say that disabilities caused or contributed to by pregnancy, miscarriage, abortion, or childbirth and subsequent recovery are temporary disabilities and should be treated as such under any health or temporary disability insurance or sick leave plan available in connection with employment. This position is affirmed by federal law under the Pregnancy Discrimination Act of 1978 (PDA).

Although companies are not required to provide any health care benefits, when they do, pregnancy must be treated the same way as any other medical condition; voluntary health care benefits must include coverage for pregnancy and pregnancy-related conditions and for those who are statistically more likely to incur high medical costs. (Note: The PDA does not require employers to pay health insurance benefits for abortion except where the life of the mother would be endangered if the fetus were carried to term or where medical complications have arisen from an abortion.)

As will be discussed later in this chapter, an employer cannot base employment decisions on the fact that a worker is pregnant, since employers must treat pregnancy the same as they would treat any other employee medical condition. If company health care is provided, maternity care must be included and coverage must be the same for spouses of males and females. Limitations on maternity coverage for preexisting conditions must be similar to limits on other conditions. If extended benefits (such as paid sick leave and benefits) are given for other disabilities, so too must extended benefits be given for pregnancies occurring during a covered period of the plan.

Once health insurance is provided, the employer is bound under federal law, including the Consolidated Omnibus Budget Reconciliation Act (COBRA) and the Employee Retirement Income Security Act (ERISA), to follow through on its promises unless the company reserved the right, in company handbooks and memos distributed to its workforce, to alter or amend promises of benefits at any time, with or without notice.

Many insurance policies have preexisting condition clauses that disallow certain kinds of coverage for medical conditions that existed prior to the employee accepting employment. This is legal, as are benefits that are capped (i.e., no more than $X of reimbursement for a particular condition per year) and the requirement that you pay for all or part of the monthly premium.

Counsel Comments:The complexity of employee benefits law is well established. New cases are constantly being decided and statutory developments implemented that have an impact on particular plans and practices. It is critical for you to constantly update and evaluate the effect of these legal developments on your own health and benefit plans. One area in particularÑretiree health care benefits and successor benefits (when a person leaves a company to work in a new job)Ñhas raised numerous problems. An employer's obligation to provide post-termination or retiree health benefits largely turns on whether those benefits are actually vested at the time of leaving. Claims for employee benefits are typically covered under federal ERISA law; speak to a qualified benefits or labor attorney for more details if applicable.

Many companies are cutting back on the amount of health coverage provided, and some companies are currently offering several plans at great expense. Often, after it is too late, employees learn that their health coverage is inadequate.

To avoid this scenario, always understand the minimum coverage you are receiving and what you must pay on your own for additional basic protection. Answers to the following questions can help you in this area.