Guide to Counseling on Employer- Sponsored Health Coverage
|
|
- Norah Holt
- 8 years ago
- Views:
Transcription
1 Guide to Counseling on Employer- Sponsored Health Coverage February 2012 Table of Contents Introduction... 1 Assessing Current Health Coverage and Needs... 2 Understanding Employer-Sponsored Group Health Coverage... 3 Health Coverage Issues when Starting a Job... 4 HIPAA and Pre-existing Condition Exclusionary Periods... 5 Health Coverage Issues During Employment... 6 Resolving Issues with Employer-sponsored Group Health Coverage... 7 Health Coverage Issues when Leaving a Job... 8 COBRA and Medicare... 9 Additional Resources Introduction The purpose of this guide is to provide information that a CWIC can use when counseling beneficiaries on health coverage from an employer. The guide explains the basics of employersponsored health coverage. It also explains important laws that protect the beneficiary when 1 P age
2 they start a job, during the job, and when they leave the job. Two of these laws are the Health Insurance Portability and Accountability Act (HIPAA) and the Consolidated Omnibus Budget Reconciliation Act (COBRA). By sharing the information in this guide, you can help the beneficiary to make informed decisions about their employer-sponsored health coverage. The guide is organized so that you can quickly jump to the information and section that you need, based on the current situation of the beneficiary. You may use the guide, for example, when you are performing an initial assessment of the beneficiary s health coverage, or when the beneficiary is starting a new job. The Health Coverage Planning Questionnaire is a tool with questions that you can ask the beneficiary to help them think about their health coverage choices. When you are using the questionnaire, you can refer back to this guide for additional information. Assessing Current Health Coverage and Needs The first step in counseling a beneficiary on health coverage is performing an assessment of current health coverage. What type of health coverage does the beneficiary have now? You can use the Health Coverage Planning Questionnaire to record this basic information. A beneficiary may have coverage through Medicaid, Medicare, VA health benefits, health coverage from an employer, or coverage on a family member s health plan. If the beneficiary does not have health coverage, or if the beneficiary needs to decide whether or not to accept health coverage from a job, you may want to perform a health care needs assessment. What are the beneficiary s current health care needs and are these needs being met with existing health insurance? You can use the questions on page two of the Health Coverage Planning Questionnaire for this assessment. Some of the key questions to look at with the beneficiary are: What kind of health coverage does the beneficiary currently have? Are there health care needs that are not being met? How important is it for the beneficiary to find new or additional health coverage? Do the beneficiary s family members have health coverage? The answers to these questions can help the beneficiary when deciding whether or not to enroll in an employer-sponsored health plan. If the beneficiary does not have health coverage, it is important to help them explore possible options for health coverage. Medicaid is important to consider if the beneficiary does not have Medicaid. Many SSDI beneficiaries are not aware that they can qualify for Medicaid based on 2 P age
3 their disability. Other possible options are health coverage from employment or coverage on a family member s health plan. Many cities and counties have low-income health insurance programs. Lastly, programs such as Medicaid and the Children s Health Insurance Program (CHIP) can offer health coverage to the child of a beneficiary that has no coverage. Tip: The beneficiary can go to HealthCare.gov: Find Insurance Options at to learn more about health coverage options in their state. Understanding Employer-Sponsored Group Health Coverage Public versus Private Health Coverage Beneficiaries will access health coverage through both public programs and private health insurance. Medicaid, Medicare and VA health benefits are public health programs. Private health coverage can either be individual or group coverage. Private individual coverage is health insurance that an individual purchases directly from a health insurance company. It can be very expensive and is often a last resort for individuals without other health coverage. Private individual health insurance is not based on employment. Private group health coverage is coverage from an employer and is called employer-sponsored group coverage. This type of private health insurance is not purchased as an individual but as a member of a group (the employees). If the beneficiary goes to work and is offered health coverage, this coverage is private employer-sponsored group health coverage. Types of Employer-Sponsored Health Plans Employers offer a variety of different types of health coverage plans. Common types include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of Service Plans. An important difference between these types of plans is which medical providers the beneficiary is allowed to use. Different health plans will have different costs to the beneficiary for covered medical services and prescription drugs. These costs are called out-of-pocket costs because they are costs that the beneficiary pays out of his or her own pocket. The employer can provide the beneficiary with a Summary Plan Description of the group health plan. This Summary Plan Description explains in detail what medical services are covered and how much the beneficiary will have to pay. 3 P age
4 Health Coverage Issues when Starting a Job Waiting Periods Many employers have a waiting period before health coverage for new employees begins. For example, an employee may have to wait for three months before the health coverage starts. Under federal law, the maximum waiting period allowed is six months. If the health plan offered is a Health Maintenance Organization, the HMO may have an affiliation period instead. Affiliation periods are similar to waiting periods. However, if there is an affiliation period, there cannot be a pre-existing condition exclusionary period. Affiliation periods cannot last longer than 3 months. Deciding Whether or Not to Enroll in Employer Health Coverage When a beneficiary begins a job, he or she may have to decide whether or not to enroll in the employer health plan. There may be a choice of several different health plans or coverage options. These can be important decisions for the beneficiary. The Health Coverage Planning Questionnaire has questions that you can ask the beneficiary in order to help them make these decisions. In general, it is better to have multiple types of health coverage. This might be Medicaid and employer-sponsored health coverage. Some beneficiaries will have Medicaid, Medicare and health coverage from a job. Having Medicaid allows the beneficiary to receive care at the lowest cost. Medicare and employer-sponsored health coverage provide more covered services than Medicaid, and usually allows the beneficiary to have more choices in medical providers. When there is a cost to the employee involved, the decision whether or not to enroll in employer-sponsored coverage becomes more complicated. The beneficiary must weigh the pros and cons of enrolling in the group health coverage. Here are some questions the beneficiary should consider: Is the health plan free or there a cost to the employee for the coverage? Are there several different plans or options offered? What are the costs for these? Does the current coverage that the beneficiary has meet all of their health care needs? Are there additional services provided by the employer s plan that the beneficiary wants to access? Does the plan offer coverage of family members? Is this important to the beneficiary? If there are several plans offered, the beneficiary will have to choose one based on their health care needs and the costs of the different plans. They will want to look at the Summary Plan 4 P age
5 Description to see the services that are covered and the out-of-pocket costs for services. These costs include deductibles and co-payments for different covered services, and costs for prescription drugs under the plan. Tip: If the state has a Health Insurance Premium Payment (HIPP) program, and if the beneficiary is on Medicaid, then Medicaid may be willing to pay the premiums for the employer-sponsored group coverage. For more details, ask Medicaid or look on the state Medicaid website to see if your state has a HIPP program. HIPAA and Pre-existing Condition Exclusionary Periods Summary If a beneficiary has had prior health coverage (such as Medicaid) before enrolling in an employer health plan, they can use that previous coverage to reduce or eliminate any preexisting condition exclusionary period. Employer-sponsored health plans are allowed to have a pre-existing condition exclusionary period, which is a period of time in which the beneficiary is excluded from coverage of benefits for pre-existing medical conditions. This means that if the beneficiary has certain pre-existing health conditions, treatment of those conditions may not be covered for a period of time. Under federal law, pre-existing condition exclusionary periods cannot last more than 12 months (or 18 months if the beneficiary enrolls late in the health plan). The Health Insurance Portability and Accountability Act of 1996 (HIPAA) contains regulations that limits health plans use of pre-existing condition exclusionary periods in several ways. Firstly, a health condition only qualifies as pre-existing condition if medical advice, diagnosis, care, or treatment was received in the 6 months prior to enrollment in the new health plan. Because of this, many health conditions will not count as pre-existing conditions. Secondly, HIPAA allows the employee to use prior coverage to reduce or eliminate a pre-existing condition exclusionary period. If a beneficiary has had health coverage from a previous job, or has Medicaid or Medicare, this coverage can be used to eliminate a pre-existing condition exclusionary period, as long as there was not a break of more than 63 days in which the beneficiary had no health coverage. Note: Most WIPA-eligible beneficiaries will not be subject to a pre-existing condition exclusionary period because they will have had prior health coverage through Medicaid or Medicare. 5 P age
6 Where to find more information on HIPAA The U.S. Department of Labor has an easy-to-read guide to HIPAA and group health coverage called Your Health Plan And HIPAA... Making The Law Work For You : More information can also be found on the U.S. Department of Labor website: Health Coverage Issues During Employment Special Enrollment Periods Normally, if an employee wants to make a change to their employer-sponsored health coverage, he or she will need to wait until a certain time of the year, called the Annual Open Enrollment period. During this period, the employee can enroll in the employer coverage, add a family member to the plan, or make any changes to their employer-sponsored health coverage. Under federal HIPAA law, employees can make changes outside the window of the Annual Open Enrollment period if certain events occur. These are called qualifying events and give the employee a Special Enrollment Period in which they can make changes to their employer health plan, enroll in the plan, or add a family member onto the plan. This HIPAA rule is important to beneficiaries because it can ensure that working beneficiaries do not go without health coverage if they lose other health coverage. If a beneficiary does not enroll in employersponsored health coverage, and then loses their Medicaid, they have a 30-day window in which they can enroll in the employer-sponsored health plan. They do not have to wait for the Annual Open Enrollment period, and will not have a period of time without any health coverage. Example: Jane is working at a bank. She receives SSDI and her Medicare has not started yet. When Jane started working, she decided not to enroll in the employersponsored health plan because she had Medicaid. She felt she did not need the extra health coverage, and did not want to pay the monthly premiums. Now Jane has received a promotion and a pay raise. She finds out that with her higher income she is no longer eligible for Medicaid. Under HIPAA, she has 30 days after her Medicaid ends to enroll in the employer-sponsored health plan. She does not have to wait until January for the Annual Open 6 P age
7 Enrollment period. If she did have to wait until January, she would have to go six months without any health coverage. HIPAA helps her gain access to the employer health coverage immediately. There are several qualifying events that can provide an employee with a Special Enrollment Period. These events include gaining a family member through marriage, birth, or adoption. If any family member loses any type of health coverage, this is a qualifying event under HIPAA. For example, if a beneficiary s spouse or child loses Medicaid, the beneficiary will have a 30-day Special Enrollment Period in which to add them on to the health plan at the beneficiary s job. You can learn more about HIPAA and Special Enrollment Periods in the U.S. Department of Labor publication Your Health Plan And HIPAA... Making The Law Work For You ( Resolving Issues with Employer-sponsored Group Health Coverage A beneficiary may disagree with an employer-sponsored health plan s decision about what services will be covered and paid for by the plan. When this happens, the beneficiary may not understand their rights or know how to appeal a decision. The CWIC can provide information on steps the beneficiary can take to resolve a dispute. The CWIC can also tell the beneficiary where they can receive additional assistance in resolving a dispute. In general, the first step for the beneficiary is to follow the health plan s internal process for making an appeal. If this does not resolve the issue, the beneficiary can continue to appeal. The human resources department of the employer may also be able to provide assistance with a dispute with the health plan. Health plans are required to follow state and federal rules for handling enrollees complaints and appeals. If an internal review process within the health plan does not resolve the dispute, there is most likely an outside external review process determined by state law. The links below provide information about this process in your state. At least 43 states have an external review process that the beneficiary can use in a dispute with their health plan. CWICs and beneficiaries can learn more by reading A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan at Your state may have an agency that helps consumers resolve disputes with health insurance plans. Visit the web page titled A Consumer Guide to Handling Disputes with Your Private or Employer Health Plan: State-By-State External Review Programs at and follow the link for your state. Here you will find information on health insurance appeals in your state, and contact information for state agencies that can help the beneficiary. 7 P age
8 Your state s Department of Insurance can provide assistance with disputes with a health plan. Many states also have a separate agency that helps consumers who are covered under a managed care plan. Health maintenance organizations, preferred provider organizations, and point-of-service plans are all managed care plans. Contact information for these agencies can be found at and Health Coverage Issues when Leaving a Job COBRA Review COBRA (from the Consolidated Omnibus Budget Reconciliation Act) is a federal law that gives an employee the right to continue their health coverage when they leave a job. More specifically, COBRA gives an employee the right to choose to continue their employersponsored health coverage, for themselves and for any dependents, if the coverage has ended for certain reasons. In order to qualify for COBRA, an employee must have lost group health coverage because of: 1) voluntary or involuntary termination of employment, for reasons other than gross misconduct, or 2) a reduction in the hours worked. The employee can enroll in COBRA coverage and will have to pay a monthly premium to continue the individual or family health coverage plan. Note: There are other events can cause the employee or a family member to lose health coverage and become eligible to continue that coverage using COBRA. These events include: the death of a covered employee, divorce or legal separation, becoming entitled to Medicare, and a child s loss of dependent status under a health plan. The most common situation involving COBRA is when an employee leaves a job and wants to continue coverage for themselves or family members. An employee will be eligible for COBRA if they work for a private company with at least 20 employees, or for a state or local government. COBRA does not apply to employees of the federal government. Continuing Coverage under COBRA Beneficiaries can use COBRA to continue health coverage after a job ends for up to 29 months (because they are disabled according to Social Security). People who are not disabled according 8 P age
9 to Social Security can continue coverage for up to 18 months. States may have laws that allow the beneficiary to continue coverage for a longer period. The group health plan must give the employee an Election Notice of their COBRA rights when an event such as the end of employment occurs. The employee can also ask for information on continuing coverage, including how much monthly premiums will be. The employee has 60 days to choose whether or not to elect continuation coverage under COBRA. There will not be a gap in health coverage if they do enroll. Coverage under COBRA will start when coverage from employment ends. The beneficiary will have to pay up to the full cost of the health coverage each month. This will be more than the monthly premium they were paying when employed. Using COBRA to continue health coverage can be very expensive. CWICs need to help the beneficiary consider less expensive health coverage options, such as Medicaid or coverage on a family member s health plan. The beneficiary may want to continue dental coverage only, or to use COBRA for a few months only, until they can secure other health coverage. COBRA and Medicare If an SSDI beneficiary becomes eligible for Medicare, their COBRA coverage will end. If the beneficiary already has Medicare and becomes eligible for COBRA coverage, the beneficiary can choose to continue coverage under COBRA. However, this may not make sense due to the cost of the monthly COBRA premiums. It is not advisable for a beneficiary to drop Medicare Part B and enroll in COBRA coverage because, should the beneficiary later decide to pick up Part B again, he/she may have to pay a late enrollment penalty. Where to find more information on COBRA The best source of information on COBRA can be found on the U.S. Department of Labor website at and You can also read a more detailed guide to COBRA at: Information on State COBRA Laws 40 states have laws that expand COBRA protections. You can find information on your State s laws related to COBRA at: =5. 9 P age
10 At you can find state information and a link to the State agency governing COBRA laws in your state. Note that this is a private company s webpage verify the information with your state agency. Additional Resources Health Insurance Consumer Guides for the Fifty States (Provides information on HIPPA, COBRA and private health coverage laws in your state. Guide to the Family and Medical Leave Act (FMLA) (National Partnership for Women & Families) =958 Family and Medical Leave Act website by the US Department of Labor Medicare and Other Health Benefits: Your Guide to Who Pays First (CMS Publication No , Revised May P age
Continuing Coverage under COBRA
Continuing Coverage under COBRA The right to purchase a temporary extension of health coverage was created by the Consolidated Omnibus Budget Reconciliation Act of 1985, a federal law commonly known as
More informationWORK CHANGES REQUIRE HEALTH CHOICES PROTECT YOUR RIGHTS EMPLOYEE BENEFITS SECURITY ADMINISTRATION UNITED STATES DEPARTMENT OF LABOR
WORK CHANGES REQUIRE HEALTH CHOICES PROTECT YOUR RIGHTS EMPLOYEE BENEFITS SECURITY ADMINISTRATION UNITED STATES DEPARTMENT OF LABOR Work Changes Require Health Choices... Protect Your Rights Opportunities
More informationIllinois Insurance Facts Health Insurance Continuation Rights -- COBRA. Illinois Department of Insurance
Illinois Insurance Facts Health Insurance Continuation Rights -- COBRA Illinois Department of Insurance Updated July 2014 Note: This information was developed to provide consumers with general information
More informationBasic COBRA Facts. Coverage and eligibility
Basic COBRA Facts Overview Facts about COBRA coverage, eligibility, and rights and responsibilities of COBRA participants. Coverage and eligibility Qualifying events and length of coverage Responsibilities
More informationGeneral Notice. COBRA Continuation Coverage Notice (and Addendum)
University Human Resources Benefits Office 3810 Beardshear Hall Ames, Iowa 50011-2033 515-294-4800 / 1-877-477-7485 Phone 515-294-8226 FAX General Notice And COBRA Continuation Coverage Notice (and Addendum)
More informationInitial Notice of COBRA Continuation Coverage Rights Time Inc. Ventures Group Benefits Plan and Cafeteria Plan
Initial Notice of COBRA Continuation Coverage Rights Time Inc. Ventures Group Benefits Plan and Cafeteria Plan Introduction You are receiving this notice because you have recently become covered under
More informationYour Right to HealthCare Coverage When Leaving or Switching Jobs
Your Right to HealthCare Coverage When Leaving or Switching Jobs Part of PHLP s Healthcare For Workers Publication Series A Consumer s Guide to Accessing Health Care Through Employment Copyright 2007 The
More informationIllinois Insurance Facts
Illinois Insurance Facts Health Insurance Continuation Rights -- Illinois Law Revised December 2003 With the high costs of medical care, maintaining health coverage is very important to most individuals
More informationLaborers Metropolitan Detroit Health Care Fund
Laborers Metropolitan Detroit Health Care Fund A VERY IMPORTANT NOTICE ABOUT CONTINUATION OF YOUR GROUP HEATH CARE COVERAGE TO: ALL EMPLOYEES AND DEPENDENTS PARTICIPATING IN THE LABORERS METROPOLITAN DETROIT
More informationDeciding Whether to Elect COBRA Health Care Continuation Coverage After Enactment of HIPAA INTRODUCTION
Deciding Whether to Elect COBRA Health Care Continuation Coverage After Enactment of HIPAA Notice 98-12 INTRODUCTION A key decision that millions of Americans face each year is whether to elect COBRA 1
More informationFederal Continuation Health Coverage Laws
Provided by: Capital Insurance Group Federal Continuation Health Coverage Laws PROVISION REQUIREMENTS COBRA applies to group health plans maintained by: Covered Employers Private-sector employers with
More informationHealth Insurance in West Virginia
Cancer Legal Resource Center 919 Albany Street Los Angeles, CA 90015 Toll Free: 866.THE.CLRC (866.843.2572) Phone: 213.736.1455 TDD: 213.736.8310 Fax: 213.736.1428 Email: CLRC@LLS.edu Web: www.disabilityrightslegalcenter.org
More informationIllinois Insurance Facts Health Insurance Continuation Rights Dependent Children. Illinois Department of Insurance
Illinois Insurance Facts Health Insurance Continuation Rights Dependent Children Illinois Department of Insurance Revised July 2014 Note: This information was developed to provide consumers with general
More informationContinuation Coverage Rights Under COBRA
Continuation Coverage Rights Under COBRA If you have and/or will become covered under the Bowling Green State University (BGSU) Group Insurance Plan (the Plan) it is important to know your COBRA rights.
More informationSample COBRA OnQue Notice
General Notice of COBRA Continuation Coverage Rights Sample COBRA OnQue Notice Mr. John Doe 123 Main Street Anytown, CA 00000 From: Subject: Your Group Health Coverage Continuation Rights under COBRA IMPORTANT
More informationThis booklet constitutes a small entity compliance guide for purposes of the Small Business Regulatory Enforcement Fairness Act of 1996.
This publication has been developed by the U.S. Department of Labor, Employee Benefits Security Administration (EBSA). To view this and other EBSA publications, visit the agency s Website at dol.gov/ebsa.
More informationGeneral Notification of Your COBRA Rights and Responsibilities
(11/6/2015) Mark Porter - Cobra-Notice-for-2016-from-Infinisource.doc Page 1 General Notification of Your COBRA Rights and Responsibilities General Notice-D HMO Blkt Mailing Date: November 5, 2015 From:
More informationContinuation of Health Benefits Under COBRA
HC-0262-1214 Fact Sheet #30 INTRODUCTION The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 requires that most employers sponsoring group health plans offer employees and their
More informationAn Employer s Guide to Group Health Continuation Coverage Under COBRA
An Employer s Guide to Group Health Continuation Coverage Under COBRA The Consolidated Omnibus Budget Reconciliation Act EMPLOYEE BENEFITS SECURITY ADMINISTRATION UNITED STATES DEPARTMENT OF LABOR This
More informationImportant Laws and Notices
Newborn & Mothers Health Protection Act Under Federal law, group health plans and health insurance issuers offering group health insurance coverage generally may not restrict benefits for any hospital
More informationHealth Insurance in Ohio
Cancer Legal Resource Center 919 Albany Street Los Angeles, CA 90015 Toll Free: 866.THE.CLRC (866.843.2572) Phone: 213.736.1455 TDD: 213.736.8310 Fax: 213.736.1428 Email: CLRC@LLS.edu Web: www.cancerlegalresourcecenter.org
More informationFAQs about COBRA Continuation Health Coverage
FAQs about COBRA Continuation Health Coverage Q1: What is COBRA continuation health coverage? Congress passed the landmark Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions
More informationPaperwork Reduction Act statement
Instructions: Massachusetts-Specific Model COBRA Continuation Coverage Election Notice For use by Massachusetts Employers and Employees The Department of Labor has developed a model Consolidated Omnibus
More informationCONTINUATION COVERAGE NOTIFICATION (COBRA)
CONTINUATION COVERAGE NOTIFICATION (COBRA) This notice has important information about your right to continue your health coverage in the Texas Employees Group Benefits Program (GBP), as well as other
More informationHealth Insurance in Kentucky
Cancer Legal Resource Center 919 Albany Street Los Angeles, CA 90015 Toll Free: 866.THE.CLRC (866.843.2572) Phone: 213.736.1455 TDD: 213.736.8310 Fax: 213.736.1428 Email: CLRC@LLS.edu Web: www.disabilityrightslegalcenter.org
More informationA Consumer Guide to Continuation of Group Health Insurance Coverage
A Consumer Guide to Continuation of Group Health Insurance Coverage Prepared by the Iowa Insurance Division Consumer Advocate 330 Maple Street Des Moines, IA 50319 877-955-1212 http://www.insuranceca.iowa.gov
More informationEmployer Health Insurance Forum. Presentation by the South Dakota Division of Insurance
Employer Health Insurance Forum Presentation by the South Dakota Division of Insurance Employer Assistance Program Zaniya Task Force Recommendation HB1027 allows agents/insurers to provide insurance related
More informationIllinois Insurance Facts Illinois Department of Insurance Health Insurance Continuation Rights (mini-cobra) The Illinois Law
Illinois Insurance Facts Illinois Department of Insurance Health Insurance Continuation Rights (mini-cobra) The Illinois Law Updated July 2009 Note: This information was developed to provide consumers
More informationHow To Continue Health Insurance Coverage In Illinois
Illinois Insurance Facts Illinois Department of Insurance Health Insurance Continuation Rights (mini-cobra) The Illinois Law Updated July 2014 Note: This information was developed to provide consumers
More informationCONTINUING YOUR BENEFITS
CONTINUING YOUR BENEFITS A COBRA How-To Guide Under federal law, you have the right to continue your employersponsored health insurance coverage after you lose coverage through your employer. The COBRA
More informationComplex Case Scenarios Preventing Gaps in Health Care Coverage Mini-Series: Transitioning from Employer-Sponsored Coverage to Other Health Coverage
Complex Case Scenarios Preventing Gaps in Health Care Coverage Mini-Series: Transitioning from Employer-Sponsored Coverage to Other Health Coverage Center for Consumer Information and Insurance Oversight
More informationAN EMPLOYEE S GUIDE TO HEALTH BENEFITS UNDER COBRA EMPLOYEE BENEFITS SECURITY ADMINISTRATION UNITED STATES DEPARTMENT OF LABOR
AN EMPLOYEE S GUIDE TO HEALTH BENEFITS UNDER COBRA EMPLOYEE BENEFITS SECURITY ADMINISTRATION UNITED STATES DEPARTMENT OF LABOR This publication has been developed by the U.S. Department of Labor, Employee
More informationPennsylvania Mini-Cobra Law
Pennsylvania Mini-Cobra Law Pennsylvania Insurance Department On June 10, 2009 Governor Edward G. Rendell signed Act 2 of 2009 to help address the growing need to extend health care options for those newly
More informationComparison of Federal and New York Continuation Laws
COBRA NEW YORK Comparison of Federal and New York Continuation Laws Covered Employers and Plan Coverage Qualified Beneficiaries (Employee / Dependents) FEDERAL (COBRA) Group health plans maintained by
More informationERISA PLANS INTRODUCTION
CHAPTER 11 ERISA PLANS What is it? ERISA, the federal Employee Retirement and Income Security Act, was enacted in 1974, largely to regulate employee pension funds. Although the law was originally enacted
More informationHealth Insurance in Georgia
Cancer Legal Resource Center 919 Albany Street Los Angeles, CA 90015 Toll Free: 866.THE.CLRC (866.843.2572) Phone: 213.736.1455 TDD: 213.736.8310 Fax: 213.736.1428 Email: CLRC@LLS.edu Web: www.cancerlegalresourcecenter.org
More informationCarpenters Health and Security Plan of Western Washington
Carpenters Health and Security Plan of Western Washington COBRA Coverage Election Notice This notice contains important information about your right to continue your health care coverage in the Carpenters
More informationHealth Insurance Coverage
Protecting Your Health Insurance Coverage This booklet explains... Your rights and protections under recent Federal law How to help maintain existing coverage Where you can get more help For additional
More informationGuide to Finding Health Insurance Coverage
Guide to Finding Health Insurance Coverage Idaho Are you uninsured? You are not alone. Millions of Americans are without health insurance. Some lost their insurance when they lost their jobs. Others work
More informationFAQs about COBRA. FAQs About COBRA Continuation Health Coverage. 1 Discovery Benefit Solutions (DBS): 888 490 7530
FAQs About COBRA Continuation Health Coverage What is COBRA continuation health coverage? Congress passed the landmark Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions in
More informationUser Guide. COBRA Employer Manual
Experience Excellence COBRA Manual User Guide COBRA Employer Manual COBRA Responsibilities and Deadlines Under COBRA, specific notices must be provided to covered employees and their families explaining
More informationINFORMATION ON THE CONTINUATION OF GROUP HEALTH INSURANCE COVERAGE FOR NEW EMPLOYEES AND DEPENDENTS UNDER THE PROVISIONS OF COBRA IMPORTANT NOTICE
HC-0247-1108q INFORMATION ON THE CONTINUATION OF GROUP HEALTH INSURANCE COVERAGE FOR NEW EMPLOYEES AND DEPENDENTS UNDER THE PROVISIONS OF COBRA IMPORTANT NOTICE CONSOLIDATED OMNIBUS BUDGET RECONCILIATION
More informationINSIDE. Manage Complexities, Help Avoid Penalties. ibx.com/cobra. An Employer s Guide to COBRA
Manage Complexities, Help Avoid Penalties The recent ruling by the Supreme Court of the United States upholding the Health Care Reform Act does not affect an employer s obligation to offer COBRA continuation
More informationEffective Date: The date on which coverage under an insurance policy begins.
Key Healthcare Insurance Terms Agent: A person who represents an insurance company and solicits or sells the company s insurance products. An agent may represent a single company or multiple companies.
More informationContinuation of. Health Insurance Benefits
Continuation of Health Insurance Benefits 1 Consolidated Omnibus Budget Reconciliation Act (COBRA) Coverage may be continued for up to 18 months through COBRA for the same or reduced coverage You will
More informationGROUP HEALTH INSURANCE INITIAL CONTINUATION NOTIFICATION
Human Resources Development 200 Bloomfield Avenue West Hartford, CT 06117 www.hartford.edu/hrd Street City, State, Zip Code Date of Notification: Coverage Effective Date: RE: GROUP HEALTH INSURANCE INITIAL
More informationNew York COBRA Continuation Coverage Q&A
New York COBRA Continuation Coverage Q&A IMPORTANT NOTE: All statements contained in this Q&A document are for informational purposes only and should not be viewed as either legal or income tax advice.
More informationThis booklet constitutes a small entity compliance guide for purposes of the Small Business Regulatory Enforcement Act of 1996.
This publication has been developed by the U.S. Department of Labor, Employee Benefits Security Administration (EBSA), and is available on the Web at www.dol.gov/ebsa. For a complete list of EBSA publications,
More informationSummary Plan Description for the North Las Vegas Fire Fighters Health and Welfare Trust Health Reimbursement Arrangement Plan
Summary Plan Description for the Health Reimbursement Arrangement Plan General Benefit Information Eligible Expenses All expenses that are eligible under Section 213(d) of the Internal Revenue Code, such
More informationInitial COBRA Notification
JIM GIBBONS Governor LESLIE A. JOHNSTONE Executive Officer STATE OF NEVADA PUBLIC EMPLOYEES BENEFITS PROGRAM 901 S. Stewart Street, Suite 1001 Carson City, Nevada 89701 Telephone (775) 684-7000 (800) 326-5496
More informationComparison of Federal and New Jersey Continuation Laws
COBRA NEW JERSEY Comparison of Federal and New Jersey Continuation Laws Covered Employers and Plan Coverage Qualified Beneficiaries (Employee / Dependents) FEDERAL (COBRA) Group health plans maintained
More informationComparison of Federal and New Jersey Continuation Laws
COBRA NEW JERSEY Comparison of Federal and New Jersey Continuation Laws Covered Employers and Plan Coverage Qualified Beneficiaries (Employee / Dependents) FEDERAL (COBRA) Group health plans maintained
More informationGuide to Finding Health Insurance Coverage
Guide to Finding Health Insurance Coverage New Jersey Are you uninsured? You are not alone. Millions of Americans are without health insurance. Some lost their insurance when they lost their jobs. Others
More informationComparison of Federal and California Continuation Laws
COBRA CALIFORNIA Comparison of Federal and California Continuation Laws Covered Employers and Plan Coverage Qualified Beneficiaries (Employee / Dependents) Continuation Period FEDERAL (COBRA) Group health
More informationCoinsurance A percentage of a health care provider's charge for which the patient is financially responsible under the terms of the policy.
Glossary of Health Insurance Terms On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. When making decisions about health coverage, consumers should
More informationGuide to Finding Health Insurance Coverage
Guide to Finding Health Insurance Coverage Georgia Are you uninsured? You are not alone. Millions of Americans are without health insurance. Some lost their insurance when they lost their jobs. Others
More informationGuide to Finding Health Insurance Coverage
Guide to Finding Health Insurance Coverage Are you uninsured? You are not alone. Millions of Americans are without health insurance. Some lost their insurance when they lost their jobs. Others work hard,
More informationBALTIMORE CITY PUBLIC SCHOOLS
HEALTH BENEFITS AT A GLANCE BENEFITS - OVERVIEW City Schools offers a comprehensive benefits package that includes: Medical Dental Vision Prescription Life Insurance and Accidental Death & Dismemberment
More informationSECTION 6.25 HEALTH INSURANCE Last Update: 06/09
SECTION 6.25 HEALTH INSURANCE Last Update: 06/09 Types of Insurance and Specific Carriers Health insurance is provided through Wellmark Blue Cross and Blue Shield. Blue Cross and Blue Shield coverage is
More informationGuide to Finding Health Insurance Coverage
Guide to Finding Health Insurance Coverage New Hampshire Are you uninsured? You are not alone. Millions of Americans are without health insurance. Some lost their insurance when they lost their jobs. Others
More informationHow To Buy Health Insurance. An Introduction To Healthcare Coverage
How To Buy Health Insurance An Introduction To Healthcare Coverage Table of Contents What Is Health Insurance? How Do I Get Health Insurance? When Can I Get Health Insurance? What Terms Should I Know?
More informationModel COBRA Continuation Coverage Election Notice (For use by single-employer group health plans)
[Enter date of notice] Model COBRA Continuation Coverage Election Notice (For use by single-employer group health plans) Dear: [Identify the qualified beneficiary(ies), by name or status] This notice contains
More informationAn Employer s Guide to Group Health Continuation Coverage Under COBRA
An Employer s Guide to Group Health Continuation Coverage Under COBRA The Consolidated Omnibus Budget Reconciliation Act U.S. Department of Labor Employee Benefits Security Administration This publication
More informationGuide to Finding Health Insurance Coverage
Guide to Finding Health Insurance Coverage Florida Are you uninsured? You are not alone. Millions of Americans are without health insurance. Some lost their insurance when they lost their jobs. Others
More informationA CONSUMERS GUIDE TO INDIVIDUAL HEALTH INSURANCE IN ARIZONA
A CONSUMERS GUIDE TO INDIVIDUAL HEALTH INSURANCE IN ARIZONA Published by the Arizona Department of Insurance Janet Napolitano, Governor Charles R. Cohen, Director of Insurance August 2003 1 Table of Contents
More informationCOBRA and HIPAA Administration Services let us take the burden from you
COBRA and HIPAA Administration Services let us take the burden from you PO BOX 1300 MANCHESTER NH 03105-1300 1-888-401-3539 FAX: 603-647-4668 THE CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT of 1985
More informationPrograms. Summary of State Programs and Laws Highlighted in Faces of Maryland s Newly Insured. Medical Assistance for Families (SB 6)
Programs Summary of State Programs and Laws Highlighted in Faces of Maryland s Newly Insured Medical Assistance for Families (SB 6) Medical Assistance for Families provides full health care insurance to
More informationMedicare and Employer-Based Coverage T he Basics
Medicare and Employer-Based Coverage T he Basics What is Medicare? A federal health insurance program Run by the Centers for Medicare and Medicaid Services (CMS) Benefit decisions controlled by the U.S.
More informationIMPORTANT INFORMATION ABOUT YOUR COBRA CONTINUATION COVERAGE RIGHTS
IMPORTANT INFORMATION ABOUT YOUR COBRA CONTINUATION COVERAGE RIGHTS What is continuation coverage? Federal law requires that most group health plans (including this Plan) give employees and their families
More informationComparison of Federal and Louisiana Continuation Laws
COBRA LOUISIANA Comparison of Federal and Louisiana Continuation Laws Covered Employers and Plan Coverage Qualified Beneficiaries (Employee / Dependents) Continuation Period FEDERAL (COBRA) Group health
More informationHMSA s. COBRA Assist INSTRUCTION GUIDE C ONSOLIDATED O MNIBUS B UDGET R ECONCILIATION A CT
HMSA s COBRA INSTRUCTION GUIDE To assist employers in meeting their obligations under the final federal COBRA regulations, HMSA s COBRA contains sample notices that incorporate the new requirements. As
More informationSUMMARY PLAN DESCRIPTION
SUMMARY PLAN DESCRIPTION of the UFCW Local 1459 and Contributing Employers Health and Welfare Fund RESTATED AND AMENDED AS OF JANUARY 1, 2011 This booklet describes the benefits available to Plan Participants
More informationOptions. Key Health Insurance Terms. A state-by-state guide to helping Americans navigate their. public and private health coverage options
U.S. FHCE s Directory of Health Glossary Care of Options Key Health Insurance Terms A state-by-state guide to helping Americans navigate their public and private health coverage options glossary of terms
More informationSection 125 Qualifying Events. Revised June 2013
Section 125 Qualifying Events Revised June 2013 Section 125: Qualifying Events Page 2 of 6 A Section 125 Cafeteria Plan must provide that participant elections are irrevocable and cannot be changed during
More informationGuide to Finding Health Insurance Coverage
Guide to Finding Health Insurance Coverage Are you uninsured? You are not alone. Millions of Americans are without health insurance. Some lost their insurance when they lost their jobs. Others work hard,
More information**CONTINUATION COVERAGE RIGHTS UNDER COBRA** BorgWarner Inc. Flexible Benefits Plan
**CONTINUATION COVERAGE RIGHTS UNDER COBRA** BorgWarner Inc. Flexible Benefits Plan Introduction This notice contains important information about your right to COBRA continuation coverage, which is a temporary
More information24HourFlex 7100 E. Belleview Ave. Suite 300 Greenwood Village, CO 80111 7/8/2015
24HourFlex 7100 E. Belleview Ave. Suite 300 Greenwood Village, CO 80111 Demo Guy & Family 7100 E. Belleview Ave. Ste 300 Greenwood Village, CO 80111 7/8/2015 Dear Demo Guy & Family: As your life events
More informationHealth Insurance and Women
Health Insurance and Women Q: What is health insurance? A: Health insurance is a formal agreement to provide and/or pay for medical care. The health insurance policy describes what medical services are
More informationMESQUITE INDEPENDENT SCHOOL DISTRICT 405 East Davis St. Mesquite, TX 75149
MESQUITE INDEPENDENT SCHOOL DISTRICT 405 East Davis St. Mesquite, TX 75149 DATE: November 7, 2014 TO: Employee, and, if applicable, Spouse and all elected covered dependents FROM: RE: Mesquite ISD Benefits
More information407-767-8554 Fax 407-767-9121
Florida Consumers Notice of Rights Health Insurance, F.S.C.A.I, F.S.C.A.I., FL 32832, FL 32703 Introduction The Office of the Insurance Consumer Advocate has created this guide to inform consumers of some
More informationConsumer Guide to. Health Insurance. Oregon Insurance Division
Consumer Guide to Health Insurance Oregon Insurance Division The Department of Consumer and Business Services, Oregon s largest business regulatory and consumer protection agency, produced this guide.
More informationGENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Fred Hutchinson Cancer Research Center Health & Welfare Benefits Plan
GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS Fred Hutchinson Cancer Research Center Health & Welfare Benefits Plan Introduction You are receiving this notice because you are currently covered under
More informationGuide to Finding Health Insurance Coverage
Guide to Finding Health Insurance Coverage Are you uninsured? You are not alone. Millions of Americans are without health insurance. Some lost their insurance when they lost their jobs. Others work hard,
More informationGuide To Understanding Insurance
Guide To Understanding Insurance Table of Contents Introduction... 1 Health Insurance Programs Overview... 2 Health Insurance... 2 Traditional Indemnity Plans... 2 Self-Funded Insurance... 3 Taft-Hartley
More informationCOBRA AND Cal-COBRA. What is COBRA?
COBRA AND Cal-COBRA What is COBRA? The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) is a federal law enacted to help prevent gaps in healthcare coverage. COBRA applies in general to companies
More informationFAQs for Employees about COBRA Continuation Health Coverage
FAQs for Employees about COBRA Continuation Health Coverage U.S. Department of Labor Employee Benefits Security Administration March 2011 Q1: What is COBRA continuation health coverage? Congress passed
More informationCOBRA Common Questions: Definitions
Brought to you by Taylor Insurance Services COBRA Common Questions: Definitions What is COBRA? COBRA stands for the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA is a federal statute
More informationYour hours of employment are reduced; or Your employment ends for any reason other than your gross misconduct.
CONTINUATION COVERAGE RIGHTS UNDER COBRA You (as a covered employee, retiree, spouse or dependent) are receiving this notice because you have recently become covered under the Bates College Group Health
More informationComparison of Federal and California Continuation Laws
COBRA CALIFORNIA Comparison of Federal and California Continuation Laws Covered Employers and Plan Coverage Qualified Beneficiaries (Employee / Dependents) Continuation Period FEDERAL (COBRA) Group health
More informationHEALTH INSURANCE OPTIONS FOR PEOPLE ON MEDICARE DUE TO DISABILITY
HEALTH INSURANCE OPTIONS FOR PEOPLE ON MEDICARE DUE TO DISABILITY io n a He Pro gram Seniors SHIIP lth at Ins urance Inform North Carolina Department of Insurance Seniors Health Insurance Information Program
More informationDATE: February 2013. Employee and Family. Human Resources, New Jersey City University. Notification of Health Benefits Rights Under Federal Law
DATE: February 2013 TO: FROM: SUBJECT: Employee and Family Human Resources, New Jersey City University Notification of Health Benefits Rights Under Federal Law This letter provides information about health
More informationComparison of Federal and Illinois Continuation Laws
COBRA ILLINOIS Comparison of Federal and Illinois Continuation Laws Covered Employers and Plan Coverage Qualified Beneficiaries (Employee / Dependents) Continuation Period FEDERAL (COBRA) Group health
More informationUnderstanding the ObamaCare Health Insurance Plans in North Carolina Understanding Insurance and Affordable Care Act Terminology: ACA- Marketplace
Understanding the ObamaCare Health Insurance Plans in North Carolina As a result of the Affordable Care Act (a.k.a. ObamaCare) the following provisions are now in place for health insurance policies with
More informationWATCO COMPANIES, LLC 2015 HEALTH PLAN NOTICES
WATCO COMPANIES, LLC 2015 HEALTH PLAN NOTICES TABLE OF CONTENTS 1. Medicare Part D Creditable Coverage Notice 2. HIPAA Comprehensive Notice of Privacy Policy and Procedures 3. Notice of Special Enrollment
More informationModel Supplemental Information Notice CEA
Model Supplemental Information Notice CEA Model COBRA Continuation Coverage Supplemental Notice (For use by group health plans for qualified beneficiaries currently enrolled in COBRA coverage to advise
More informationHUMAN RESOURCES POLICIES AND PROCEDURES
HUMAN RESOURCES POLICIES AND PROCEDURES Area: Benefits Number: 2400 Subject: Group Insurance Program Issued: 7/2008 Applies To: Campus Benefitted Employees Revised: Sources: Page(s): 1 of 5 Purpose To
More informationThe Right To Continue COBRA Coverage
COBRA CONTINUATION OF COVERAGE Consolidated Omnibus Budget Reconciliation Act (COBRA) COBRA is an acronym for the federal law known as the Consolidated Omnibus Budget Reconciliation Act of 1985. A provision
More informationAn Employer s Guide to Group Health Continuation Coverage Under COBRA
An Employer s Guide to Group Health Continuation Coverage Under COBRA The Consolidated Omnibus Reconciliation Act of 1986 U.S. Department of Labor Employee Benefits Security Administration This publication
More informationThis glossary provides simple and straightforward definitions of key terms that are part of the health reform law.
This glossary provides simple and straightforward definitions of key terms that are part of the health reform law. A Affordable Care Act Also known as the ACA. A law that creates new options for people
More information