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Major health problems can be devastating for families in many ways. If a family member becomes seriously ill, they might lose their job – which can lead to loss of insurance. And those caring for a sick family member may experience their own issues with taking leave from employment, obtaining medical insurance, and making financial decisions for the family. But all workers have certain rights, including when it comes to dealing with health issues.
If you become seriously ill and need to take time off from work, you may have a legal right to do so under the Family and Medical Leave Act (“FMLA”). The FMLA also allows workers to take time off to care for a sick family member.
The FMLA provides leave for workers as long as they:
“Covered employers” are private-sector employers with 50 or more employees, as well as all public agencies. It can also include smaller offices if the employer has 50 or more employees within 75 miles.
If you are covered by FMLA, you are eligible to take up to 12 weeks of unpaid leave for:
You may take FMLA leave in increments, as needed; your leave time is not required to be taken consecutively. However, employers often require employees to use any available sick, personal, or vacation time before they are permitted to take unpaid leave.
If you or a family member who is covered by your medical insurance plan becomes seriously ill, the Health Insurance Portability and Accountability Act (“HIPAA”) prohibits insurance companies from discriminating against you in any way. For example, an insurance company may not charge different premiums or rates for a person diagnosed with cancer, deny coverage for their treatment, or otherwise exclude them from coverage. Similarly, an insurance company may not prohibit you from enrolling in a medical insurance plan if you are ill or do not meet specific health standards.
The Consolidated Omnibus Budget Reconciliation Act (“COBRA”) helps extend insurance coverage for workers who lose their job due to illness.
COBRA applies to all employers with 20 or more employees and requires that you be able to purchase medical insurance through your former employer at the same price for up to 18 months following the loss of your employment. Although maintaining medical coverage under COBRA can be expensive, it is typically cheaper than a private health insurance policy.
You can purchase private insurance policies on your own. But, they are typically more expensive and carry higher deductibles than those from an employer. Furthermore, these individual insurance policies may not cover some medical conditions or certain types of treatment.
If you or a family member suffer from a severe health condition, there may be programs available in your state for public health insurance coverage. Also, most children are eligible to be covered under state Medicaid programs if specific financial requirements are met. Likewise, adults who are disabled may qualify for medical insurance through state Medicaid disability programs.
The requirements for eligibility, as well as the coverage, vary widely from state to state and are dependent on each state's laws and regulations that govern these programs. Likewise, if you or a family member is permanently disabled and/or over the age of 65, coverage may be available through Medicare. There are no income limits on Medicare coverage. Still, you will be responsible for some monthly premiums and co-pays, just like a private health insurance policy.
If you require emergency medical care, and you do not have health insurance, you can still receive emergency care. Under the Emergency Medical Treatment and Active Labor Act (“EMTALA”), all healthcare facilities must aid anyone coming in for emergency medical treatment.
An emergency medical condition exists when symptoms are so severe that failure to provide medical treatment could result in serious harm. While EMTALA requires all healthcare facilities to provide emergency medical treatment if needed, it does not cover anything beyond emergency care. That includes follow-up care. However, some for-profit hospitals have their own policies to provide some degree of medical care at no cost.
This article is intended to be helpful and informative. But even common legal matters can become complex and stressful. A qualified health insurance lawyer can address your particular legal needs, explain the law, and represent you in court. Take the first step now and contact a local health insurance attorney to discuss your specific legal situation.