Health Insurance Benefits

How do my employer-provided health, life, and disability insurance plans work?

At DeBofsky, Sherman & Casciari, PC , our attorneys are focused on health, life, and disability benefits and ERISA. Healthcare and other benefit plans provided by an employer, union or other employee organization are governed by ERISA. ERISA sets forth the minimum standards that a plan must follow to be legal. ERISA establishes:

  • Plan information disclosure requirements
  • Fiduciary responsibilities for plan managers
  • Internal grievance processes for denied claims
  • Standing to sue for breach of fiduciary duty or benefits

One of the most important pieces of information provided by ERISA to plan participants and their beneficiaries is the summary plan description (SPD). The SPD describes how the plan works, including:

  • Who is eligible for the plan
  • How the plan operates
  • How service and benefits are determined and calculated
  • How benefits are paid
  • Which health insurance benefits are included

An experienced ERISA attorney can assist Illinoisans with understanding their SPDs and what to know about benefits.

Can my benefits run out or get canceled if I become disabled?

In the past, if you had employer-provided insurance governed by ERISA, the answer to this question was yes in both regards. Your benefits could run out, and insurance companies would attempt to drop subscribers who were diagnosed with costly illnesses. However, disability insurance law has changed. The Affordable Care Act (ACA) has significantly changed the rules insurance companies must follow.

Under the old rules, health benefits could be denied for pre-existing conditions or for any details you misstated or forgot to include when you enrolled in a benefit program. If the insurance company discovered improperly disclosed or undisclosed information, even through an honest mistake, it rescinded the health insurance benefits. The ACA changed the rules and only permits the recession of your benefits if you intentionally falsify or fail to disclose important information. Additionally, under the ACA, lifetime benefits limits are being phased out. Currently, plans that began on or after September 23, 2012 have a $2 million benefit limit. Beginning January 1, 2014, the final phase of the ACA takes effect and no annual benefit limit applies.

What happens to my insurance plan if I lose my job?

When ERISA was originally passed, if you lost your job, you also immediately lost your health insurance. The Consolidated Omnibus Budget Reconciliation Act (COBRA) permits many workers to temporarily continue their employer-provided health plan despite:

  • Loss of job
  • Reduction in hours
  • Change of job
  • Death of the spouse who provided benefits
  • Divorce

COBRA's continuation of coverage typically only applies to companies of 20 employees or greater. An attorney can help you understand the rapidly changing insurance and healthcare laws and take advantage of these additional health benefits, including an extension of your COBRA benefits in the event of disability until Medicare eligibility begins.

Contact us today to better understand your insurance benefits and rights

An incomplete or inaccurate understanding of your insurance plan or benefits can deprive you of significant benefits and resources. At DeBofsky, Sherman & Casciari, PC , our attorneys can make your benefits plan coherent. To schedule your appointment, please call us at 312-702-1842 or 800-237-5182 or contact us online.