COBRA Consolidated Omnibus Reconciliation Act
If you've lost your job, don't panic yet about losing your health coverage, too. You could be eligible for the continuation of your health insurance benefits.
A federal law known as COBRA (short for the Consolidated Omnibus Budget Reconciliation Act of 1985) provides a vital bridge between health insurance plans for qualified workers, their spouses, and their dependent children when their health insurance might otherwise be cut off. Because of that security, COBRA has been hailed as a much-needed safety net for families in the midst of crisis, such as unemployment, divorce, or death.
Under COBRA, if you voluntarily resign from a job or are terminated for any reason other than "gross misconduct," you are guaranteed the right to continue your former employer’s group plan for individual or family health insurance for up to 18 months at your own expense. In many cases, your spouse and dependent children are also eligible for COBRA coverage, sometimes for as long as three years. However, individual plans — that is, plans you buy on your own, rather than through work or an association — are not subject to COBRA law, and once you lose that coverage, you won't be able to get an extension under COBRA.
Requires employers to give notice to and allow terminated employees and their dependents to elect, within a certain period of time, to continue health care coverage Applies to all employers offering group health plans except plans where an employer employed fewer than 20 employees on at least 50% of the working days, during the preceding calendar year, church plans and governmental plans. All employees who were covered under the employer's group health plan on the day before the qualifying event. Employer must pay excise tax of $100 a day per qualified beneficiary ($200 a day per family for the same qualifying event) to a maximum depending on the type of plans and the violation. Suits may result in monetary damages and an award of attorney fees.
Find more information at: www.cobrainsurance.com or Insure.com - COBRA
Department of Labor
This website provides information and services the Department of Labor (DOL) offers for employers and workers.
Find more information at: www.dol.gov
FMLA Family Medical Leave Act
Requires employers to grant eligible employees up to 12 weeks of unpaid leave each year for the birth, adoption, or foster care of a child or the serious illness of the employee or a family member. Employers who have 50 or more employees for at least 20 work weeks in the current or preceding calendar year. Any employee who has worked at least 1,250 hours during the previous 12 months at a location where the employer had at least 50 employees within a 75 mile radius. Employees may sue for lost wages and benefits caused by a violation of the Act; for damages due to increased cost of care, as well as for reinstatement of employment and promotions. Attorney fees may also be awarded. FOR MORE INFORMATION
Find more information at: The Family & Medical Leave Act
- FMLA Leave of Absence Form - Health Provider Certification - click here
- FMLA Leave of Absence Form - Employer Response to Employee - click here
HIPAA Health Insurance Portability & Accountability Act
If you're worried about keeping your health benefits when you change jobs, you should know about a federal law called HIPAA. It's the Kassebaum-Kennedy Act, also known as the Health Insurance Portability and Accountability Act of 1996.
The law was designed to ease a problem known as "job lock" — the reluctance to move from one company to another for fear of losing health coverage.
Pre-existing conditions
Health insurance companies have traditionally tried to hold down their costs by invoking a "pre-existing condition" clause — refusing to cover a condition you had before you bought a health plan.
The concept of pre-existing conditions makes sense when you're talking about auto insurance: For example, if your windshield was cracked before you bought your coverage, you can't expect your new auto insurer to replace it after you buy a policy. That would be like asking your insurer to replace the windshield for free.
When it comes to health insurance, there has long been a debate about pre-existing conditions.
Got diabetes? Your current group health plan might pay for insulin and visits to the doctor. Before HIPAA was enacted, if you switched to a new group health plan, the new insurer could consider your diabetes a pre-existing condition and refuse to cover treatment. You would then have to pay for all of your diabetes treatment, on top of the regular out-of-pocket expenses you'd pay for other medical care. The frightening prospect of having to pay hundreds or thousands of dollars for medical care created "job lock" and helped fuel the push for legislation banning such practices.
HIPAA imposes limits on the extent to which some group health plans can exclude coverage for pre-existing conditions. For instance, if you've had "creditable" health insurance for 12 straight months, with no lapse in coverage of 63 days or more, a new group health plan cannot invoke the pre-existing condition exclusion. It must cover your medical problems as soon as you enroll in the plan.
What is “creditable” coverage? It includes prior coverage you had under any of the following health plans:
- A group health plan
- Medicare
- Medicaid
- A military-sponsored health care program such as TriCare
- Health plans offered by the Indian Health Service
- A state high-risk pool
- The federal Employees Health Benefit Program
- A public health plan established or maintained by a state or local government
- A health benefit plan provided for Peace Corps members
On the other hand, if you are not switching from a “creditable” health policy when you enroll in a new group plan — or had coverage from a foreign health insurer — your new insurer can refuse to pay for any of your existing medical problems (except pregnancy, if the plan has maternity coverage). Maternity restrictions are only legal for a maximum of 12 months. Late enrollees in group health plans might have to wait up to 18 months for coverage of pre-existing conditions.
Find more information at: CMS - HIPAA or Insure.com - HIPAA
HIPAA Privacy Requirements
HIPAA Privacy Rule and Business Associate Contract
ADA Americans with Disabilities Act
Prohibits discrimination on the basis of disability. Title I covers employment, including job application procedures, hiring, advancement, discharge, compensation, job training, and all other aspects of employment. As of July 26, 1994, all employers with 15 or more employees, for at least 20 work weeks in the current or preceding calendar year. Those with a physical or mental impairment that substantially limits one or more major life activities, but who can perform the essential functions of the job. Compensatory and punitive damages for intentional discrimination subject to certain limitations, as well as attorney and expert fees. Employee may file suit in federal court if the EEOC does not.
Find more information at: Municipal Reseach & Services Center
ADEA Age Discrimination in Employment Act
Prohibits employment discrimination on the basis of age. Employers engaged in industry affecting commerce with 20 or more employees for at least 20 workweeks in the current or preceding calendar year. All workers 40 years of age and older. Employers may be required to reinstate an employee and purge his or her employment record may also be liable for back pay, liquidated damages and legal fees. EEOC. Employee has up to three years in some cases to file suit after first filing claim with EEOC.
Discrimination Checklist
TITLE VII Civil Rights Act of 1964
Prohibits discrimination on the basis of race, color, religion, sex, or national origin. Employers engaged in interstate commerce who have 15 or more employees for at least 20 weeks in the current or preceding calendar year. Employees in the protected classes. Compensatory and punitive damages for intentional discrimination subject to certain limitations, as well as attorney and expert fees. EEOC. Employee may file suit in federal court if the EEOC does not. Pregnancy Discrimination Act Prohibits discrimination on the basis of pregnancy. Employers engaged in interstate commerce who have 15 or more employees for at least 20 weeks in the current or preceding calendar year. Female employees and male employees if the discrimination affects receipt of fringe benefits by male employees' wives. Compensatory and punitive damages for intentional discrimination subject to certain limitations, as well as attorney and expert fees. EEOC. Employee may file suit in federal court if the EEOC does not.
ERISA Employment Retirement Income Security Act
Provides minimum consistent standards for employee benefits and retirement plans. Establishes reporting and disclosure requirements. All US employers with welfare benefit plans, except governmental and church plan, and plans maintained solely to comply with worker's compensation, unemployment compensation, or state disability laws. All employees eligible for the employer's welfare benefit plan or pension benefit plan. Penalties vary depending on which provisions of the Act are violated, but they include fines of up to $1,000 a day for failure to file Forms 5500 and 5500C, as well as criminal penalties for willful violations.
ERISA Description
Employee Benefits Security Administration
The Employee Benefits Security Administration (EBSA) is committed to educating and assisting the 150 million Americans covered by the 730,000 private retirement plans and six million private health and welfare plans and the plan sponsors and members of the employee benefits community. EBSA promotes voluntary compliance and facilitates self-regulation, working diligently to provide quality assistance to plan participants and beneficiaries. It is the policy of EBSA to provide the highest quality of service to its customers.
Click here for more info
Rehabilitation Act
Prohibits employment discrimination based on physical or mental handicaps. Requires affirmative action. Federal contractors and subcontractors with contracts over $10,000 and employers who receive direct federal funding. Employees with a physical or mental impairment that substantially limits one or more major life activities. Withholding of progress payments to the contractor, cancellation of the contract, and debarment from future contracts. Office of Federal Contract Compliance Programs (OFCCP) may also seek court enforcement.
Women's Health and Cancer Rights Act
The Women's Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that provides protections to patients who choose to have breast reconstruction in connection with a mastectomy. This law applies generally both to persons covered under group health plans and persons with individual health insurance coverage. But WHCRA does NOT require health plans or issuers to pay for mastectomies. If a group health plan or health insurance issuer chooses to cover mastectomies, then the plan or issuer is generally subject to WHCRA requirements.
If WHCRA applies to you and if you are receiving benefits in connection with a mastectomy and you elect breast reconstruction, coverage must be provided for:
- Reconstruction of the breast on which the mastectomy has been performed;
- Surgery and reconstruction of the other breast to produce a symmetrical appearance;
- Prostheses (e.g., breast implant); and
- Treatment for physical complications of the mastectomy, including lymphedema.
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