Health insurance clause: Copy, customize, and use instantly
Introduction
A health insurance clause establishes the terms under which employees or parties covered under the agreement will receive health insurance benefits. This clause is essential in outlining the employer's responsibilities to provide health insurance coverage, the scope of that coverage, and the responsibilities of the parties involved. It ensures that both the employer and the employee are aware of the insurance benefits available and the terms for their provision.
Below are templates for health insurance clauses tailored to different scenarios. Copy, customize, and insert them into your agreement.
Health insurance clause for employer-provided coverage
This variation applies when the employer provides health insurance coverage for employees.
The Employer agrees to provide health insurance coverage for all eligible employees. The health insurance coverage shall include medical, dental, and vision benefits, subject to the terms and conditions outlined in the plan. The Employer will pay [insert percentage]% of the premium, with the employee responsible for the remaining [insert percentage]%. Eligibility for coverage begins after [insert number of days/months] of employment.
Health insurance clause for employee contribution
This variation applies when employees are required to contribute to their health insurance coverage.
The Employer agrees to provide health insurance coverage for all eligible employees, with the employee responsible for contributing [insert percentage]% of the premium cost. The Employer will contribute the remaining [insert percentage]% of the premium. Employee contributions will be deducted directly from their salary on a [weekly/monthly] basis.
Health insurance clause for family coverage
This variation applies when health insurance coverage extends to the employee’s family members.
The Employer agrees to provide health insurance coverage for the employee and their eligible dependents, including spouse and children. The Employer will cover [insert percentage]% of the premium for the employee, and [insert percentage]% for the dependents. The employee is responsible for paying the remaining premium for family coverage.
Health insurance clause for coverage upon termination
This variation applies when health insurance coverage continues after the employee’s termination under certain conditions.
The Employer agrees to provide continued health insurance coverage for employees after termination, provided the employee elects to continue the coverage under the provisions of COBRA or other applicable law. The employee will be responsible for paying the full premium for continued coverage after termination.
Health insurance clause for health savings accounts (HSA)
This variation applies when the employer provides employees with access to a Health Savings Account (HSA).
The Employer will provide eligible employees with the option to participate in a Health Savings Account (HSA) to help pay for eligible medical expenses. The Employer will contribute [insert amount] annually to each employee’s HSA account, with employees able to make additional contributions up to the legal limit. The HSA funds will remain with the employee upon termination of employment.
Health insurance clause for health insurance plan changes
This variation applies when the employer reserves the right to change the health insurance plan.
The Employer reserves the right to modify, change, or terminate the health insurance plan at any time, provided that the Employer gives the employees [insert number of days] days' notice. Any such changes will be communicated to the employees in writing, and employees will have the option to enroll in new plans or opt out as applicable.
Health insurance clause for coverage eligibility
This variation applies to specify the eligibility requirements for health insurance coverage.
Health insurance coverage will be provided to all full-time employees who work a minimum of [insert number] hours per week. Employees must complete [insert number of days/months] of continuous employment before becoming eligible for health insurance benefits. Temporary, part-time, or seasonal employees are not eligible for health insurance coverage under this Agreement.
Health insurance clause for coverage during maternity/paternity leave
This variation applies when health insurance is extended during maternity or paternity leave.
The Employer agrees to continue health insurance coverage for employees on maternity or paternity leave for up to [insert number of weeks/months]. The Employer will continue to pay [insert percentage]% of the premium during the leave, and the employee will be responsible for paying the remaining portion. Employees may return to the same level of health coverage upon their return to work.
Health insurance clause for wellness programs
This variation applies when health insurance includes access to wellness programs.
The Employer will provide health insurance coverage that includes access to wellness programs, such as gym memberships, smoking cessation programs, or weight loss initiatives. The Employer may cover the cost of these programs or may offer a reimbursement program for employees who participate in eligible wellness activities.
Health insurance clause for coverage for pre-existing conditions
This variation applies when health insurance coverage includes provisions for pre-existing conditions.
The health insurance coverage provided under this Agreement will cover pre-existing conditions as defined by the plan. Any exclusions related to pre-existing conditions will be subject to the terms of the insurance policy and applicable laws. The Employer will ensure that the plan complies with any relevant state or federal regulations regarding pre-existing conditions.
Health insurance clause for mental health coverage
This variation applies when health insurance includes mental health services.
The Employer’s health insurance coverage will include mental health services, such as counseling, therapy, and psychiatric care, in accordance with the terms of the plan. The Employer will ensure that employees have access to mental health resources and that these services are covered as part of the overall health insurance benefits.
Health insurance clause for dental and vision coverage
This variation applies when dental and vision coverage are included in the health insurance plan.
The health insurance coverage provided by the Employer will include dental and vision care benefits. The Employer will pay [insert percentage]% of the premium for dental and vision coverage, with the employee responsible for the remaining [insert percentage]%. Coverage will include routine exams, preventive care, and necessary treatments as specified in the plan.
Health insurance clause for dependent coverage continuation
This variation applies to continuation of health insurance coverage for dependents after the employee leaves.
If an employee’s coverage terminates, the employee’s dependents may continue to receive health insurance coverage under the Employer’s plan, subject to the terms of COBRA or similar continuation laws. The employee or their dependents may be required to pay the full premium cost for continued coverage, including any administrative fees.
Health insurance clause for compliance with applicable law
This variation applies when the health insurance plan complies with all applicable laws.
The Employer agrees to provide health insurance coverage that complies with all applicable federal, state, and local laws, including the Affordable Care Act (ACA). The Employer will ensure that the health insurance coverage meets all regulatory requirements and will provide employees with any required notices regarding their rights under the law.
Health insurance clause for opt-out option
This variation applies when employees are offered the option to opt-out of health insurance coverage.
Employees may opt out of the Employer’s health insurance plan if they can demonstrate that they have alternative health insurance coverage. If an employee chooses to opt-out, they must provide proof of alternative coverage to the Employer. The employee will not be eligible for any health insurance benefits under this Agreement if they opt out.
Health insurance clause for temporary coverage during probationary period
This variation applies when temporary health insurance is provided during the employee’s probationary period.
Employees who are in their probationary period of employment will be provided with temporary health insurance coverage. The terms of this temporary coverage will mirror the standard health insurance benefits provided under this Agreement, but the employee will be responsible for paying [insert percentage]% of the premium until the probationary period ends.
Health insurance clause for coverage with waiting period
This variation applies when a waiting period is required before health insurance coverage is activated.
Employees will become eligible for health insurance coverage after completing a waiting period of [insert number of days/months] from the date of hire. Coverage will begin on the first day of the month following the end of the waiting period, and the employee will be responsible for paying [insert percentage]% of the premium.
Health insurance clause for part-time employee coverage
This variation applies when part-time employees are eligible for health insurance.
Part-time employees who work at least [insert number] hours per week will be eligible for health insurance benefits under this Agreement. The Employer will cover [insert percentage]% of the premium cost, and the employee will be responsible for the remaining balance.
Health insurance clause for voluntary coverage options
This variation applies when employees have the option to voluntarily enroll in additional coverage.
In addition to the standard health insurance coverage provided by the Employer, employees will have the option to voluntarily enroll in additional coverage options, including dental, vision, and life insurance. The employee will be responsible for paying the full premium for any additional coverage elected.
Health insurance clause for employer contribution cap
This variation applies when the employer sets a cap on their contribution towards premiums.
The Employer will contribute up to a maximum of [$insert amount] per month towards the employee's health insurance premiums. The employee will be responsible for any premium costs exceeding the Employer’s contribution cap.
Health insurance clause for opt-in wellness programs
This variation applies when employees have the option to participate in wellness programs.
The Employer offers voluntary wellness programs, including fitness reimbursements, smoking cessation programs, and mental health resources. Employees who choose to participate in these programs will be eligible for reimbursements or services as specified in the health insurance plan, subject to plan limits.
Health insurance clause for coverage for domestic partners
This variation applies when health insurance covers domestic partners.
The Employer agrees to provide health insurance coverage for the employee’s domestic partner, subject to the terms and conditions outlined in the health insurance policy. The employee will be responsible for paying any additional premium cost associated with adding the domestic partner to the plan.
Health insurance clause for coverage during temporary leave
This variation applies to health insurance continuation during a temporary leave of absence.
Employees on temporary leave (e.g., medical leave or family leave) are entitled to continue health insurance coverage under this Agreement. The employee will be responsible for paying their portion of the premium during the leave, and the Employer will continue to cover its portion as per the standard terms of the health plan.
Health insurance clause for coverage for retirees
This variation applies when health insurance is extended to retirees.
The Employer will provide health insurance coverage for eligible retirees who have completed [insert number] years of service. Retirees will be responsible for paying [insert percentage]% of the premium, with the Employer covering the remaining [insert percentage]% of the premium.
Health insurance clause for coverage during probation period
This variation applies when health insurance is provided during the probation period.
Employees on probation will be eligible for health insurance coverage starting on the first day of the month following their [insert number of days/months] probationary period. The Employer will pay [insert percentage]% of the premium, with the employee responsible for the remaining [insert percentage]%.
Health insurance clause for coverage changes due to life events
This variation applies when health insurance coverage changes following qualifying life events.
In the event of a qualifying life event, such as marriage, birth of a child, or loss of other health coverage, employees may make changes to their health insurance coverage within [insert number of days] days of the event. Employees must notify the Employer within the specified time frame to adjust their coverage accordingly.
Health insurance clause for continuation of coverage during layoffs
This variation applies when health insurance is continued during a layoff period.
In the event of a layoff, employees may continue their health insurance coverage under COBRA for up to [insert number of months]. The employee will be responsible for paying the full premium during this period, including any administrative fees associated with COBRA continuation.
Health insurance clause for coverage during short-term disability
This variation applies to health insurance continuation during short-term disability leave.
Employees on short-term disability leave are entitled to maintain health insurance coverage under this Agreement. The employee will continue to contribute to the premium costs, and the Employer will cover its portion of the premium during the disability period.
Health insurance clause for coverage after voluntary resignation
This variation applies when health insurance coverage continues after voluntary resignation under specific conditions.
Employees who voluntarily resign from the company may continue health insurance coverage under the Employer’s plan for up to [insert number of months] after their resignation. The employee will be responsible for paying the full premium during this period.
Health insurance clause for part-time employees with limited benefits
This variation applies when part-time employees receive limited health insurance benefits.
Part-time employees working fewer than [insert number] hours per week will not be eligible for full health insurance benefits. However, they may be eligible for a limited benefits package, which will include [insert specific benefits], subject to availability and Employer discretion.
Health insurance clause for pregnancy-related coverage
This variation applies to health insurance coverage for pregnancy-related services.
Health insurance coverage will include benefits for pregnancy-related care, including prenatal visits, childbirth, and postnatal care. Employees who are pregnant or planning to become pregnant will have access to these services under the terms of the health plan provided by the Employer.
Health insurance clause for dental and vision coverage
This variation applies to the inclusion of dental and vision coverage as part of health insurance.
The Employer’s health insurance coverage will include dental and vision benefits for eligible employees. The Employer will contribute [insert percentage]% of the premium for dental and vision coverage, with the employee responsible for the remaining [insert percentage]% of the premium.
Health insurance clause for employer's right to amend coverage
This variation applies when the employer has the right to amend the health insurance plan.
The Employer reserves the right to amend, modify, or discontinue the health insurance coverage provided to employees at any time, with prior written notice of [insert number of days] days. Any changes to the plan will be communicated to employees in a timely manner.
Health insurance clause for coverage during a personal leave of absence
This variation applies to health insurance coverage during a personal leave of absence.
Employees on personal leave of absence will have the option to continue their health insurance coverage under the terms of the Employer’s health plan. The employee will be responsible for paying [insert percentage]% of the premium, and the Employer will continue to cover [insert percentage]% of the premium during the leave period.
Health insurance clause for coverage with extended family benefits
This variation applies when the health insurance plan includes coverage for extended family members.
The Employer will provide health insurance coverage that extends to the employee’s spouse, children, and other eligible dependents as defined in the plan. The Employer will cover [insert percentage]% of the premium for the employee’s coverage, and [insert percentage]% for the dependents. The employee will be responsible for any remaining premium costs.
Health insurance clause for catastrophic coverage
This variation applies when the plan includes catastrophic health coverage.
The Employer will provide catastrophic health insurance coverage for all eligible employees, which covers the major medical expenses after a high deductible. The employee is responsible for paying the deductible amount, and the Employer will cover the remaining medical expenses subject to the plan’s terms.
Health insurance clause for coverage of medical expenses abroad
This variation applies when the plan includes coverage for medical treatment abroad.
The Employer’s health insurance plan will cover medical expenses incurred abroad under certain conditions. The employee will be eligible for coverage for emergency medical treatment while traveling internationally, with the Employer covering [insert percentage]% of the costs. Non-emergency treatments abroad may not be covered.
Health insurance clause for temporary workers
This variation applies to health insurance for temporary employees.
Temporary employees who are employed for a duration of [insert number of months] or more will be eligible for the Employer’s health insurance plan. Eligibility will begin after the completion of [insert number of months] of continuous service, and the employee will be responsible for [insert percentage]% of the premium.
Health insurance clause for high-deductible health plans (HDHP)
This variation applies when the plan includes a high-deductible health plan (HDHP) option.
The Employer will offer employees the option to enroll in a high-deductible health plan (HDHP) that qualifies for a Health Savings Account (HSA). The Employer will contribute [$insert amount] annually to the employee’s HSA, and the employee will be responsible for meeting the higher deductible amount before the plan covers expenses.
Health insurance clause for coverage with network restrictions
This variation applies when the insurance plan has network restrictions.
The health insurance coverage provided under this Agreement will include access to a specified network of healthcare providers. Employees will need to use in-network providers for maximum coverage; out-of-network services will be covered at a reduced rate, with the employee responsible for paying the difference in costs.
Health insurance clause for dependent eligibility verification
This variation applies when dependent eligibility verification is required.
The Employer requires employees to verify the eligibility of their dependents for health insurance coverage. Employees must submit documentation such as birth certificates, marriage certificates, or other proof of dependency for the Employer to approve coverage for dependents. The employee is responsible for any discrepancies or issues related to dependent verification.
Health insurance clause for coverage after retirement
This variation applies to health insurance continuation after retirement.
Retired employees who have completed at least [insert number of years] of service with the Employer will be eligible to continue their health insurance coverage after retirement. The employee will be responsible for paying the full premium cost after retirement, and the Employer will not contribute to the premium after the retirement date.
Health insurance clause for coverage during short-term illness
This variation applies to health insurance coverage during a short-term illness.
Employees who are unable to work due to a short-term illness will continue to receive health insurance coverage under this Agreement. The employee will be responsible for continuing to pay their portion of the premium during the illness, and the Employer will maintain its portion of the coverage until the employee is able to return to work.
Health insurance clause for coverage for preventative care
This variation applies to coverage for preventive care services.
The Employer’s health insurance plan includes coverage for preventive care services, such as annual check-ups, immunizations, and screenings. These services will be covered at 100% by the Employer, with no cost-sharing required for the employee, provided the services are performed by in-network providers.
Health insurance clause for health insurance continuation during furlough
This variation applies when coverage is extended during furlough periods.
Employees placed on furlough due to economic or operational reasons will retain their health insurance coverage under this Agreement for a period of up to [insert number of months]. Employees will continue to be responsible for paying their portion of the premium during the furlough period, with the Employer covering its portion of the premiums.
Health insurance clause for employee-funded plan options
This variation applies when employees have the option to choose plans with different levels of coverage and cost.
The Employer will offer employees a range of health insurance plan options, with varying levels of coverage and associated costs. Employees may select the plan that best suits their needs, with the employee responsible for paying the premium associated with their selected plan. The Employer will contribute to the cost of a basic health plan.
Health insurance clause for coverage for pre-existing conditions
This variation applies when coverage includes pre-existing conditions.
The Employer’s health insurance plan will cover pre-existing conditions as part of the benefits. Employees with pre-existing health conditions will be eligible for the same coverage as other employees, with no exclusions or waiting periods for such conditions, in compliance with applicable laws.
Health insurance clause for coverage eligibility for seasonal employees
This variation applies to health insurance eligibility for seasonal employees.
Seasonal employees who work for a minimum of [insert number of hours] per year may be eligible for health insurance coverage under the Employer’s plan. Coverage will begin after [insert number of months] of employment, and employees will be responsible for contributing to their portion of the premiums.
Health insurance clause for wellness program incentives
This variation applies when health insurance is linked to wellness program participation.
The Employer will offer wellness program incentives to employees who actively participate in the health and wellness programs provided under the Employer’s health insurance plan. Employees who meet specific wellness goals, such as regular exercise or smoking cessation, will receive premium reductions or other incentives as specified in the program.
Health insurance clause for dental and vision coverage
This variation applies when dental and vision benefits are included in the health insurance plan.
The health insurance coverage provided by the Employer includes dental and vision benefits for eligible employees. The Employer will contribute [insert percentage]% of the premiums for dental and vision coverage, with employees responsible for the remaining [insert percentage]% of the premium.
Health insurance clause for coverage for elective surgeries
This variation applies when elective surgeries are covered under the health insurance plan.
The Employer’s health insurance coverage will include coverage for elective surgeries, including but not limited to, cosmetic procedures and non-emergency medical treatments, subject to the terms of the insurance plan. Coverage for such procedures may be subject to specific conditions or limitations outlined in the plan.
Health insurance clause for temporary employees without benefits
This variation applies to temporary employees who are not eligible for health insurance benefits.
Temporary employees who work less than [insert number of hours] per week or for fewer than [insert number of months] will not be eligible for health insurance benefits under this Agreement. These employees may be offered the option to purchase health insurance through a third-party provider at their own expense.
Health insurance clause for employee-only coverage
This variation applies when only the employee is covered under the plan.
The Employer will provide health insurance coverage for the employee only. The employee may elect to add eligible dependents to the plan at their own expense. The Employer will cover [insert percentage]% of the premium for employee-only coverage, and the employee will be responsible for the remaining premium.
Health insurance clause for coverage during extended leave
This variation applies when health insurance is maintained during extended leave.
Employees on extended leave of absence for up to [insert number of months] will retain their health insurance coverage, with the employee responsible for paying their portion of the premium. The Employer will continue its contribution toward the premium during the leave period.
Health insurance clause for coverage upon termination
This variation applies when health insurance coverage continues for a short time after termination.
Upon termination of employment, employees may continue their health insurance coverage under COBRA or other applicable regulations for a period of up to [insert number of months], with the employee responsible for paying the full premium for continuation.
Health insurance clause for premium payments via payroll deductions
This variation applies when health insurance premiums are paid through payroll deductions.
Health insurance premiums will be automatically deducted from the employee’s paycheck on a [weekly/monthly] basis. The employee is responsible for the premium contribution, as specified in the benefits section of the Agreement.
Health insurance clause for coverage for full-time employees
This variation applies to full-time employees and their eligibility for health insurance.
Full-time employees who work at least [insert number] hours per week will be eligible for the Employer’s health insurance plan. Coverage will begin on the first day of the month following the employee’s [insert number of months] of employment, with the Employer contributing [insert percentage]% of the premium.
Health insurance clause for dependent coverage eligibility
This variation applies to health insurance coverage for dependents.
The Employer will provide health insurance coverage for the employee and their eligible dependents, including the spouse and children. The employee is responsible for paying the premium for dependents, with the Employer covering [insert percentage]% of the premium for the employee.
Health insurance clause for wellness program discounts
This variation applies when the health insurance plan offers discounts for wellness program participation.
Employees who actively participate in wellness programs such as fitness classes, health screenings, or smoking cessation will be eligible for premium discounts of [insert percentage]%. The Employer will provide a list of eligible wellness programs at the beginning of each year.
Health insurance clause for coverage of prescription medications
This variation applies to the coverage of prescription medications under the health plan.
The Employer’s health insurance plan will cover the cost of prescription medications, including both generic and brand-name drugs, subject to the plan’s formulary. Employees may be required to pay a co-payment for each prescription, as specified in the health insurance policy.
Health insurance clause for coverage for emergency medical services
This variation applies to coverage for emergency medical services under the health plan.
The Employer’s health insurance coverage will include benefits for emergency medical services, including emergency room visits, ambulance transportation, and urgent care. These services will be covered at [insert percentage]% of the cost, with the employee responsible for any applicable deductible or co-insurance.
Health insurance clause for coverage under government programs
This variation applies when health insurance is provided through a government program.
The Employer agrees to offer health insurance coverage through a government-sponsored program, such as Medicaid or Medicare, for eligible employees. Employees will be responsible for meeting the eligibility requirements and enrolling in the program as applicable.
Health insurance clause for catastrophic coverage with high deductible
This variation applies to high-deductible health plans (HDHP) offering catastrophic coverage.
Employees may elect to participate in a catastrophic health insurance plan with a high deductible. The plan will cover significant medical expenses after the deductible is met, with the employee responsible for paying the deductible amount. The Employer will contribute [insert amount] annually to the employee’s Health Savings Account (HSA), where applicable.
Health insurance clause for coverage for specific medical treatments
This variation applies when health insurance includes specific treatments like physical therapy.
The Employer’s health insurance plan will cover specific medical treatments, including physical therapy, chiropractic care, and alternative medicine services, as outlined in the policy. Coverage for these services will be subject to approval by the plan administrator and will have a maximum annual benefit limit.
Health insurance clause for coordination of benefits
This variation applies to situations where an employee has multiple health insurance plans.
In the event that an employee has multiple health insurance plans, the Employer’s plan will coordinate benefits with other coverage. The Employer’s plan will be the primary insurance, and any secondary coverage will pay for the remaining eligible costs according to the terms of the plans.
Health insurance clause for temporary coverage during the probationary period
This variation applies to employees on probation who receive temporary health coverage.
Employees who are in their probationary period will receive temporary health insurance coverage, with the Employer covering [insert percentage]% of the premium. Coverage will be limited to emergency care and preventive services during this period, and full benefits will be available once the probationary period is complete.
Health insurance clause for coverage of mental health services
This variation applies when health insurance includes coverage for mental health services.
The Employer’s health insurance coverage will include mental health services, including counseling, therapy, and psychiatric treatment. Employees can access these services with a [insert percentage]% co-payment, and the Employer will cover the remaining costs according to the policy’s terms.
Health insurance clause for dental and vision insurance
This variation applies when dental and vision care are included in the health insurance plan.
The Employer’s health insurance coverage includes dental and vision care benefits for all eligible employees. The Employer will contribute [insert percentage]% of the premium for dental and vision insurance, with the employee responsible for the remaining amount, which may vary depending on the coverage level selected.
Health insurance clause for COBRA continuation coverage
This variation applies when health insurance continues under COBRA after employment ends.
Employees who terminate employment with the company will be eligible for health insurance continuation under the COBRA program. Employees will be responsible for paying the full premium, including both the Employer’s and employee’s share, plus any administrative fees required by COBRA.
Health insurance clause for opt-out of coverage
This variation applies when employees have the option to opt-out of health insurance coverage.
Employees who already have health insurance coverage through another source may opt-out of the Employer’s health insurance plan. Employees who opt-out must provide proof of alternative coverage and will not be eligible for any health insurance benefits under this Agreement.
Health insurance clause for out-of-pocket maximums
This variation applies to health insurance coverage with an out-of-pocket maximum.
The Employer’s health insurance plan will have an out-of-pocket maximum for each employee. Once the employee has met this amount in deductibles, co-payments, and coinsurance, the Employer will cover 100% of additional covered medical expenses for the remainder of the plan year.
Health insurance clause for maternity and paternity care
This variation applies when the plan covers maternity and paternity care.
The Employer’s health insurance plan will provide maternity and paternity care for employees, including prenatal visits, childbirth, and postnatal care. Coverage will also include counseling and medical support services for both parents, with the employee responsible for any applicable co-payments or deductibles.
Health insurance clause for employee reimbursement for medical expenses
This variation applies to situations where employees are reimbursed for medical expenses.
The Employer will provide reimbursement for qualifying medical expenses not covered by the employee’s health insurance plan. Employees must submit documentation of the expenses, and the Employer will reimburse up to [$insert amount] per year, subject to the terms of the reimbursement policy.
This article contains general legal information and does not contain legal advice. Cobrief is not a law firm or a substitute for an attorney or law firm. The law is complex and changes often. For legal advice, please ask a lawyer.