Health Insurance Quotes

If your employer decides to get a new health plan, you do have a choice, sort of: Take the company's health insurance plan or take nothing.

Your lack of say here might seem unfair, but remember, the insurance contract is between your employer and your health plan, not between you and your health plan.

"In most cases, if the owner of the company changes his or her mind about what the benefits will be, that's tough luck for the employee," says Jim Stevenson, a spokesperson for the Washington state Department of Insurance.

The Kansas Department of Insurance notes the same thing: "The employer does not need the consent of the plan participants to change companies, make changes to the plan, cancel the policy, or agree to new premiums or benefits."

Indeed, most employers have broad discretion in switching plans regardless of what the workers want. Under ERISA, the federal Employee Retirement Income Security Act, companies that are self-insured — generally larger employers — are exempt from state health insurance laws anyway. So even if a state does have laws granting employees certain rights, those self-insured companies would not have to comply. Instead, self-insured companies are governed only by federal law through the U.S. Department of Labor.

If your company is a union shop, though, your contract might spell out the conditions under which you are given health care benefits. And those conditions could give you the right to decide which HMO or other health plan you want, or even the specific benefits you get and your premiums. The union might be able to vote on the issue and could overrule the company's desire to switch plans.

To some, it is a big deal

You might not mind that you don't have a say over which health plan your employer selects. Big deal, you might think, if you're like some people and visit your doctor only once every couple of years.

But say you (or your wife) have breast cancer and you've been seeing a specialist for three years — a doctor who knows the intimate details of your illness, who has seen you through rounds of chemo, and who doesn't have to thumb through your thick medical chart to find out who the heck you are.

And when you get your new HMO's list of doctors, your cancer specialist isn't there. What then? Do you have to spend months trying to bring a new doctor up to speed on your condition? Develop rapport with a stranger?

Families USA, a consumer advocacy group, notes that it's more than mere inconvenience when employers change health plans, forcing employees to find new doctors. "A sudden involuntary change of providers can have damaging medical and psychological repercussions for persons undergoing care for a chronic or disabling condition, in the midst of a life-threatening illness, or in the middle of pregnancy," the organization notes in a 1998 report on continuity of care titled "Hit and Miss: State Managed Care Laws."

In most states, there are laws to govern a patient's ability to continue care under certain specific conditions, such as a life-threatening illness, an ongoing pregnancy or a chronic condition that requires continuity of care. Check with your employee-benefits administrator as soon as you are told about any changes to your health insurance to assure continued care in these situations. Your state department of insurance can tell you what the insurance laws are in your state.