Group health: accidents/illness work related excluded if no workers comp, if 0 or 1 employee

Aug 1, 2018

  1. yorkriver1

    yorkriver1 Guru

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    I looked at an 11 year old thread on here that stated no group medical coverage would cover work related injuries for self employed people. Not sure about this, is it still a blanket thing, or carrier specific. I am speaking of ACA rules based small group medical plans.

    Sole proprietor type owners with zero employees can now buy group insurance in my state, but they may need to buy workers comp to have coverage for work related injury, if not also illness, if the work related exclusion is still active in ACA based employer group coverage. I suppose it would have to be something like whether workers comp paid it or not, and thus the question at all medical facilities about the visit being work related. The clause I found in a group certificate of coverage doesn't speak of exclusion but of the coverage not being a replacement for WC or the type of coverage that could be claimed in addition to it.

    Coverage for office/outside sales people is inexpensive, but for contractors actively doing the work it could be pretty pricey.

    In my state one owner with 2 or more employees besides the owner is required to buy WC. If they have even one employee, they should buy it, because legal liability. Hard to convince just the sole owner unless the group won't cover them for work related accidents/illness.