HEALTH CARE OPTIONS FOR DISLOCATED WORKERS Department of Workforce Development Workforce Programs...
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Transcript of HEALTH CARE OPTIONS FOR DISLOCATED WORKERS Department of Workforce Development Workforce Programs...
HEALTH CARE OPTIONS FOR DISLOCATED
WORKERS
Department of Workforce DevelopmentWorkforce Programs Roundtable, May 18, 2010
Presenters
Gesina Mentink, State Rapid Response Coordinator, Department of Workforce Development
Jodie Mender, Department of Health Services
What is a “Dislocated Worker?”
Someone who loses his or her job through no fault of his or her own
Possible Health Insurance Options:
COBRA and “mini-COBRA” Special enrollment BadgerCare programs Private individual insurance policy WI Health Insurance Risk Sharing Plan (HIRSP) Free or low cost clinics Discount prescription programs The Health Coverage Tax Credit (HCTC)
Consolidated Omnibus Budget Reconciliation Act (COBRA) Federal law giving workers the right to continue their
group health plans for a limited time after losing their coverage due to a “qualifying event”
Establishes minimum requirements for continuation coverage
Generally applies to all group health plans maintained by employers with at least 20 employees
It is a continuation of a person’s insurance plan . . . not a new plan
COBRA
What is a “qualifying event?”
An event that causes a person to lose his or her group health coverage
Examples: Termination of employment for any reason other than “gross
misconduct” Reduction of hours of employment Bankruptcy of the employer
COBRA
What types of group policies can be continued through COBRA?
Group health plans providing medical care
Includes plans for prescription drugs, dental care, and vision care
Excludes plans that only provide life insurance or disability benefits
COBRA What is the process?
A covered employee loses coverage due to qualifying event
Employer must notify the insurance provider / plan administrator of the qualifying event within 30 days
The insurance provider / plan administrator has 14 days to provide the “Election Notice” to qualified beneficiaries
The Election Notice should provide all premium information
Person has 60 days from the date the Notice is received or coverage is lost, whichever is later, to complete & return the form
Person must make an initial premium payment within 45 days after the date you mail in your election form
COBRA
When does coverage begin? Once you elect COBRA and pay for it, your continuation
coverage begins on the date that your coverage through your employer ceased
Beware of retroactive premiums!
How long will coverage last? Generally 18 months where the qualifying event is a termination
of employment
COBRA
Reasons a person may lose COBRA…
Failure to make timely premium payments 30-day grace period for payment of any premium Insurance provider / administrator is not required to send monthly premium
invoices
Employer discontinues the group health plan altogether Possible exception – Wisconsin’s Emergency Rule through the Office of the
Commissioner of Insurance (OCI)
Become insured under another group health plan (spouse’s plan or new employer’s plan) or Medicare
COBRA
What will it cost? What you paid before + employer’s contribution (+ possible 2%
administration fee)
Unless you are eligible for the COBRA premium subsidy under the American Recovery & Reinvestment Act of 2009 (ARRA) as amended by the Department of Defense Appropriations Act of 2010 (DOD) and the Temporary Extension Act of 2010 (TEA).
COBRA
What is the COBRA premium subsidy? Provides a premium reduction for up to 15 months for eligible individuals Individual responsible for only 35% of monthly premium Applies to all group health plans, including health, dental, & vision
Who is eligible for the subsidy? Involuntary termination between Sept. 1, 2008 to May 31, 2010 Qualified beneficiary who elects coverage Not eligible for other group health coverage or Medicare Income restrictions
COBRA
Other important points
“Independent rights” of qualified beneficiaries
COBRA is tied to the “active” plan Any changes made to the plan’s terms that apply to active
employees and their family members also apply to persons receiving COBRA continuation insurance
COBRA
Dept. of Labor, EBSA http://www.dol.gov/ebsa 1-866-444-EBSA (3272)
HIPAA
Health Insurance Portability & Accountability Act (HIPAA) of 1996
Provides an with various protections Allows for “special enrollment” Limits pre-existing condition exclusion periods Prohibits discrimination based on health factors Guarantees access to individual health insurance
policies in certain situations
HIPAA
What are pre-existing conditions? Any medical condition for which a person treated in the 6 months before enrolling in a new
group plan Some exceptions, including pregnancy
What are exclusionary periods? Period of time where any treatment for a pre-existing condition will not be covered by the
new group plan Generally, the max length is 12 months after one’s enrollment date
How does someone reduce or eliminate an exclusionary period?
Showing proof of “Creditable Coverage” Continuous health insurance in the last 12 months without a “significant break” (i.e. more
than 63 days) Certificate of Creditable Coverage
Special Enrollment
What is it? Allows you, spouse, and dependents (if covered by former employer’s group
health plan) to enroll in a group health plan offered by your spouse’s employer
Independent rights
Enrollment must be requested no later than 30 days after your coverage ended
Coverage begins the first day of the month after enrollment
Want more information? Dept. of Labor, EBSA
http://www.dol.gov/ebsa 1-866-444-EBSA (3272)
BadgerCare Programs
Private Individual Insurance
Contact local health insurance agents for quotes
Anybody can do this, but HIPAA guarantees access to individuals who have lost coverage under a group health plan
Certain criteria must be met including that the individual is either not eligible for COBRA or has exhausted COBRA benefits
Extent of coverage and rates vary by plan
WI Health Insurance Risk Sharing Plan (HIRSP) If you are unable to get an adequate private policy
because of a medical condition contact:
The Wisconsin Health Insurance Risk Sharing Plan (HIRSP) HIRSP
1751 W. BroadwayP.O. Box 8961Madison, WI 53708-8961800-828-4777 or(608) 221-4551
Eligibility requirements online at http://www.hirsp.org/
Free & Low Cost Clinics
Department of Health Services website http://dhs.wi.gov/, keyword search “free clinics” Or, go to http://dhs.wisconsin.gov/forwardhealth/clinics.htm
Discount Prescription Programs
Department of Health Services website http://dhs.wi.gov/, keyword search “prescription assistance” for
information abut a variety of programs Or, go to http://dhs.wisconsin.gov/guide/spec/freeprescr.htm
Under 27 years old?
Recently enacted statute provides that individuals under 27 years of age may be eligible for coverage under their parents’ group health insurance plan, Wis. Stats. 632.885
Office of the Commissioner of Insurance125 South Webster StreetMadison, Wisconsin 53703-3474(608) 266-3585 or (800) 236-8517711 (TDD) (ask for 608-266-3586)Hours: Monday - Friday 7:45 a.m. - 4:30 p.m. (except for legal holidays)
Health Coverage Tax Credit (HCTC)
What is it? Federal tax credit program administered by IRS as part of the
Trade Adjustment Assistance Reform Act (2002)
What is its purpose? Help cover the cost of health care for workers who have lost
their jobs due to foreign trade or who are receiving pension payments from the Pension Benefit Guaranty Corporation (PBGC)
Qualified family members may also receive the tax credit
THANKS!!