Work
Changes Require Healthcare Choices
-Protect Your Rights-
Your First Job
Starting your very first job? Consider enrolling in one
of your employer's healthcare plans. If your employer
offers more than one option-an HMO plan, a preferred provider
option, and a fee-for-service plan, for example-compare
each to your needs and preferences before making a decision.
Ask for a copy of the summary plan description (SPD) to
get details about covered benefits. Ask what type of healthcare
plans they have, how they work, and what eligibility requirements
you may have to meet. Know whether you will be expected
to pay a portion of your premium, how much it will be,
and who to talk to if you have questions.
Job Loss
What if your healthcare coverage ends because you lose
your job, have your hours reduced, or get laid off? Knowing
your rights ahead of time can prevent these situations
from meaning an end to healthcare coverage. Under the
Consolidated Omnibus Budget Reconciliation Act (COBRA),
you, your spouse and dependent children, might be able
to purchase extended health coverage for up to 18 months.
In the case of individuals who qualify for Social Security
disability benefits, special rules may allow for extending
coverage an additional 11 months. Since your employer
is not required to pay a portion of your premium, you
may pay the entire amount, but the cost is usually less
than if you obtained coverage on your own. Also, contact
your state government to find out if you or your dependents
are eligible for public health insurance, like Medicaid
or the new State Children's Health Insurance Programs,
or to get information on obtaining new coverage. Under
the Health Insurance Portability and Accountability
Act (HIPAA), you may also be eligible to enroll in
your spouse's healthcare plan under a special enrollment
period.
Read:
What Happens to My Insurance
if I lose My Job?
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Looking for a New Job?
Before switching, ask about the type of plans offered
by the potential employer, and compare it to your current
plan. Ask about the premium you'll pay under the new plan,
whether you can continue with the same doctors, or whether
you will have to see new ones. And know your rights under
HIPAA, which protects you and your dependents by limiting
pre-existing condition exclusion periods. COBRA may give
you the opportunity to purchase temporary extended healthcare
benefits offered by your former employer while you are
looking for a new job, or during a waiting period for
health benefits imposed by your new employer.
Retirement
When you're thinking about retiring, be sure you understand
the documents governing your healthcare plan. Review your
SPD, and any documents you have received that would modify
it. Also, request copies of any formal written documents
that outline how your plan operates, and any other information
on your employer's policies on retiree healthcare benefits.
Realize that although some employers continue to provide
healthcare benefits to their retired employees, private
sector employers are not required to provide retiree health
benefits. And remember, federal law does not prevent employers
from cutting or reducing healthcare benefits under plans
available to participants and their families, unless there
has been a specific promise to continue them that can
be legally enforced. So before you retire, think about
saving money to use for any coverage gaps that may occur
before you are eligible for Medicare.
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Brief Overview of the Healthcare
Laws:
HIPAA - Generally HIPAA limits
pre-existing condition exclusions to a maximum of 12 months
(18 months for late enrollees). HIPAA also requires this maximum
period to be reduced by the length of time you had prior "creditable
coverage." You should receive a certificate documenting
your prior creditable coverage from your old plan when coverage
ends. HIPAA may also give you a right to purchase individual
coverage if you have no group coverage available, and have
exhausted COBRA or other continuation coverage.
COBRA - If you are covered under
one of your employer's healthcare plans and you lose your
job, have your hours reduced, or get laid off, and your employer's
healthcare plan continues to exist, you and your dependents
may qualify to purchase temporary extended health coverage
under COBRA at group rates under the employer's plan. Divorce,
legal separation, loss of dependent child status, the covered
employee's death or entitlement to Medicare, may also give
your covered spouse and dependent children the right to elect
continued coverage under COBRA. Your plan must be notified
of these events. Generally, COBRA covers group healthcare
plans maintained by employers with 20 or more employees. Group
healthcare plans are required to provide you with a written
notice indicating your eligibility for COBRA coverage. If
you are eligible, you will have 60 days from the date the
notice is sent or from the date your coverage ends-whichever
is later-to elect COBRA. If the employer is too small to be
subject to COBRA, state law may require the plan's insurer
to provide some continuation coverage.
For More Information
The Department of Labor's Employee Benefits Security Administration
(EBSA) administers several important health benefit laws covering
employer-provided healthcare plans which govern your basic
rights to information on how your healthcare plans work, how
you qualify for benefits and how to make claims for benefits.
In addition, there are specific laws protecting your right
to health benefits when you lose coverage or change jobs.
EBSA also oversees recently enacted healthcare laws covering
special medical conditions.
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