Diabetes at Work: Your Rights and Benefits
By Isabel Chin, Lynn Kennedy, and Jeemin Kwon
Breaking down employer-based health insurance, employee health benefits, and employee rights for people with diabetes
The most common type of health insurance coverage in the US is employer-based insurance, covering almost 50% of all Americans in 2015. Despite its prominence, employer-based health insurance can be challenging to navigate, and living with diabetes makes the process of understanding and accessing employee health benefits like insurance all the more critical. This guide breaks down employer-based insurance, employee health benefits, and the rights of people with diabetes in the workplace.
We hope this guide helps you better understand employer-based insurance, maximize your health through work benefits, and know and protect your workplace rights as a person with diabetes.
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Currently, all US employers with over 50 full-time employees are required to provide health insurance that meets certain standards of affordability otherwise they face a fine. While small businesses are not required to offer health insurance to their employees, many companies will so they can take advantage of tax credits.
It is important to understand what coverage and health benefits your employer offers in order to choose the right insurance plan for you. Job-based health plans are required to provide a “Summary of Benefits and Coverage” (also known as an SBC) that includes standard health plan information – important for understanding the terms and comparing options. An SBC includes a benefit summary with information on the plan’s coverage and cost (e.g., deductibles, out-of-pocket limit, co-pays, co-insurance, etc.). For more information on decoding and understanding health insurance language, check out diaTribe’s guide here.
An SBC is also required by law to include “coverage examples” – or estimated coverage costs – for three medical scenarios: managing type 2 diabetes, having a baby, and emergency room treatment for a simple fracture. As such, SBCs offer a valuable way to compare individual health plans. To view an example SBC, click here. For more information and a step-by-step guide to comparing health plans, check out diaTribe’s guide here.
Compare multiple plans by looking at each plan’s coverage example for “managing type 2 diabetes” in the SBC. Note that premium costs (a monthly fee), aren’t included in the coverage examples given in the SBC.
As an employee, your health insurance provider is required to give you an SBC when you first enroll (i.e., right after being hired) and at the beginning of each new plan year (typically January 1).
You can also request a “Summary of Benefits and Coverage” from your health insurance provider at any time; they have seven days to provide it.
Though an SBC is useful for an overview of plans, it does not provide information about whether specific products (i.e. branded insulins or devices) are covered. However, you can still determine whether an insurance plan will cover the drug or device you need by calling your health insurer’s customer service line. For prescription drugs, insurance companies also provide a resource called a drug formulary, which is a list of covered prescription drugs under that plan.
Another limitation of using an SBC to compare health plans is that it does not take into account the complexity of your diabetes management, which can significantly affect out-of-pocket expenses under a health plan. It is important to discuss with your healthcare provider and know what your diabetes management plan will look like. As you would expect, the example coverage costs for managing type 2 diabetes in an SBC is more accurate for simple management than complex management plans.
Maximizing Other Diabetes-Related Health Benefits
Many employers, either through their offered health plans or through the company itself, provide employees with access to Diabetes Prevention Programs (DPP) – proven lifestyle change programs that can help prevent or delay the onset of type 2 diabetes. This is a great benefit if you are currently living with prediabetes or are at risk of developing type 2 diabetes. To see if a DPP benefit could apply to you:
Check your Summary of Coverage and Benefits (SBC) about DPP coverage or call your health insurance representative to ask about your plan’s DPP coverage policy.
Check if your employer offers DPP as a separate health benefit (which should be detailed in your job offer). Contact your employer’s HR representative if you need more information.
Check with your employer’s HR department for details on other health benefits that may be offered to employees, such as fitness and food options, coverage or other incentives for health screenings, workplace wellness programs, or other unique health programs and services.
Understanding Your Rights as a Person with Diabetes in the Workplace
Whether you are searching for a job, in the hiring process, or currently have a job, you have rights in the workplace as a person with diabetes that are protected by federal law under the Americans with Disabilities Act (ADA). The US Equal Employment Opportunity Commission (EEOC) enforces the employment provisions under the ADA – they even have a specific webpage dedicated to answering questions about diabetes.
A common question that comes up is: Do I have to tell my employer that I have diabetes? While the answer to that question may depend on the scenario (explained below), what should never change are your rights: you cannot be discriminated against because of diabetes. And if you are subject to discrimination, you can file a charge of employment discrimination with the EEOC (also below).
If you are applying for a job:
A prospective employer may not ask questions about your medical condition(s) – like whether you have diabetes or use insulin.
A prospective employer may not require you to have a medical examination before making a conditional job offer.
You do not have to disclose your diabetes unless you need a reasonable accommodation for the application process (e.g., a break to eat a snack, access to a private space to inject insulin, etc.).
If you choose to disclose your diabetes, a prospective employer may not ask questions about your diabetes, its treatment, or your prognosis. However, if an employer reasonably believes you will require an accommodation to perform the job because of your diabetes, they may ask whether you need an accommodation and what type.
After a job offer is made:
An employer may ask questions about your health and may require a medical examination as long as all applications for the job are treated equally.
If you disclose your diabetes after receiving a conditional job offer, an employer may ask you additional questions related to your diabetes such as how long you have lived with diabetes, whether you use insulin or oral medication, whether you will need assistance in the event of hypoglycemic (low blood sugar) episodes, and whether you need a reasonable work accommodation.
An employer may not withdraw an offer from an applicant with diabetes if the applicant is able to perform essential job functions, with or without reasonable accommodation.
An employer must provide reasonable accommodations that are needed because of your diabetes and its treatment. You are entitled to reasonable accommodations even if you did not voluntarily disclose you have diabetes pre-job offer.
Reasonable accommodations for diabetes can vary based on individual need, but examples include having access to private spaces to check blood glucose or take medication, working modified shifts, etc. If you are unsure of what a reasonable accommodation might entail, speaking to your healthcare provider may be helpful, such as when deciding how often to make doctor’s visits.
To request a reasonable accommodation because of your diabetes, simply tell your employer, who may request reasonable documentation (i.e., to verify you have diabetes and explain why an accommodation is needed).
The Job Accommodation Network website provides more information on workplace accommodations for people with diabetes here.
Note: Employers must keep information about any medical condition you disclose confidential.
Keep in mind that while it can be intimidating to ask for an accommodation, many accommodations will be beneficial to both you and your employer. If you are happier, healthier, and more comfortable at work, chances are you will also be more productive.
How to File a Charge of Employment Discrimination
Any person who believes that their employee rights have been violated on the basis of their diabetes and wants to make a claim against an employer can file a charge of discrimination with the US Equal Employment Opportunity Commission (EEOC).
The charge must be filed by mail or in person with a local EEOC office within 180 days from when the violation happened.
For details on the process of discrimination charges against private employers and state or local governments, click here.
For details on the process of discrimination charges against the federal government, click here.
Maintaining Employer-Based Health Insurance After a Major Life Event: Understanding COBRA
There is a federal US law called the “Consolidated Omnibus Budget Reconciliation Act” (also known as COBRA) that allows a covered employee, their spouse (or ex-spouse), and dependent children to maintain temporary health coverage – called “COBRA continuation coverage” – when insurance would otherwise be lost due to certain major life events (e.g., being fired, death of the covered employee, etc.). COBRA continuation coverage works by letting eligible people stay in the employer-based group health plan – either as an individual or as a family – for a period of 18-36 months, depending on the specific situation. This arrangement can be beneficial for many because the group rate is sometimes cheaper than purchasing an individual health plan – although, COBRA can also be very expensive.
Does COBRA apply to all employer-based health plans?
Group health plans that cover 20 or more employees and are maintained by a private employer or a local or state government fall under COBRA; those maintained by the federal government or church-related organizations may not. Beyond federal law, some states have their own continuation coverage requirements that apply to group plans even if there are fewer than 20 employees – called “mini-COBRA” requirements in some instances.
To figure out whether your group health plan is covered by COBRA, you can check your health plan’s "Summary Plan Description” (SPD; must be provided within 90 days of joining a health plan), contact the representative mentioned in your health plan’s SPD, ask your employer’s HR department, or check with your state’s insurance commissioner (find more info here).
Even if you don’t need COBRA continuation coverage right now, check your plan’s terms to see if there is anything you must do (like give notice) to protect your COBRA rights in case you need COBRA continuation coverage at a later date.
My employer-based health plan is covered by COBRA. Does that mean I’m eligible for COBRA continuation coverage?
For employees whose health plan is covered under COBRA, a “qualifying event” that results in loss of health coverage must occur to become eligible for COBRA continuation coverage. Qualifying events include:
Termination of employment (loss of job) for any reason other than “gross misconduct”
Reduction in the number of hours of employment
“Dependents” of the covered employee (spouse and children) will qualify for COBRA continuation coverage when the covered employee does, as well as in these additional circumstances:
Divorce or legal separation from the covered employee
The covered employee moving to Medicare coverage
Death of the covered employee
For more detailed information, click here for “An Employee’s Guide to Health Benefits Under COBRA” and here for answers to frequently asked questions about COBRA, both distributed by the US Department of Labor.
If COBRA continuation coverage does not sound right for you, there are other options, such as purchasing a Health Insurance Marketplace plan. A qualifying event like losing existing health coverage can make you eligible for a Special Enrollment period. See this page about whether you are eligible here and more about Marketplace plans here.
Do you have tips for making the most of employer-based insurance as a person with diabetes? Let diaTribe know!
This article is part of a series on access that was made possible by support from Lilly Diabetes. The diaTribe Foundation retains strict editorial independence for all content.