How Can I Get Health Insurance?

Health insurance obtained through your employer

Many South Carolinians get health insurance coverage through their employers. It is important to understand, however, that employers who pay for your insurance do so voluntarily – no law requires them to buy insurance for you. Employers have many options when they choose to buy health insurance for their employees.

For example, your employer may pay for insurance only for you, or may decide to offer insurance for you and your family. Employers also have to decide how much of the premium they will pay. Some employers pay the full cost for health insurance. Others require employees to pay some or the entire monthly premium. The portion of the premium that an employee has to pay is called a “contribution”.

What does it mean when my Company is “Self-Insured”?

Some employers “self-insure” the health benefit plans that cover their employees. If your employer is self-insured, it means that your employer, not an insurance company, is responsible for payment of your covered health care services. These plans may be administered by the employer itself, or the employer may contract with an outside administrator (often a health insurance company) to process claims.

Self-insured plans are regulated at the federal level by the Department of Labor. They are not subject to state insurance laws or state mandated benefits. It is sometimes hard to know whether you are insured through a regular insurance company or your employer is self-insured, since self-insured employers often contract with insurance companies to administer benefits under the employer’s policy. The best way to know is to call your employer’s human resources or personnel department, or the person who handles your company’s insurance plans, and ask.

If your employer is not self-insured, your insurance will be offered through an insurance company. Plans available to employers are either “large group” or “small group” plans, depending on the size of your company (the “group”).

· Large Group insurance is available to employers with 51 or more employees.

· Small Group insurance is available to employers with 1 to 50 employees or to those people who are self-employed.

Each of these provides comprehensive medical insurance, but different state and federal laws may affect the exact make-up of each type of plan. In both cases, your employer generally has some ability to determine what benefits will be offered and the type of plan offered. The employer can also decide whether to offer coverage to you alone, or to you and your family (dependents).

Text Box: How can I get health insurance? There are three basic ways of getting health insurance. If you work, your employer may offer you and your family health insurance as part of your benefits package, like vacation time or overtime pay. If your employer does not offer such benefits, or if you are self-employed or not working, you can buy your own insurance directly from a health insurance company. These first two ways are describe below. If you meet certain requirements your child may be eligible for one or more government health insurance programs known as Medicaid and Medicare. See Medicaid 101 for descriptions of these programs.

Strengthening Families:

Resources for Partnering for

Healthy Development of Children and Youth