hipaa question

NaeNae55

Employee is covered under spouse's health insurance. Spouse expects to be laid off next year. Due to HIPAA, when he is laid off employee will be eligible for coverage here and may join the plan at that time.

Wrinkle: Spouse's employer intends to pay health premiums for up to 7 months for their laid off employees. If I understand my HIPAA correctly, our employee will be eligible under our insurance when the 7 month period ends, and not just when the spouse terminates employment. Right? In other words, it is loss of coverage that triggers the HIPAA event. Am I right?

Nae

joannie

Nae,
I believe loss of coverage is correct when it is due to loss of employment, if I understand the following:

Qualifying Events - Qualifying events are certain events that would cause an individual to lose health coverage. The type of qualifying event will determine who the qualified beneficiaries are and the amount of time that a plan must offer the health coverage to them under COBRA. A plan, at its discretion, may provide longer periods of continuation coverage.

The qualifying events for employees are:

Voluntary or involuntary termination of employment for reasons other than gross misconduct

Reduction in the number of hours of employment

The qualifying events for spouses are:

Voluntary or involuntary termination of the covered employee's employment for any reason other than gross misconduct

Reduction in the hours worked by the covered employee

Covered employee's becoming entitled to Medicare

Divorce or legal separation of the covered employee

Death of the covered employee

If you want to check this out the site is:

[url]http://www.dol.gov/ebsa/FAQs/faq_compliance_cobra.html[/url]

NaeNae55

COBRA isn't quite what I was looking for, but it helped me find what I needed. This is from the DOL website as you suggested, just a slightly different area ([url]http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html[/url]):

What are my new group health plan's obligations with respect to special enrollment opportunities?

A group health plan is required to allow special enrollment for certain individuals to enroll in the plan without having to wait until the plan's next regular enrollment season.

Group health plans and health insurance issuers are required to provide special enrollment periods during which individuals who previously declined coverage for themselves and their dependents may be allowed to enroll (without having to wait until the plan's next open enrollment period).

A special enrollment opportunity occurs if an individual with other health insurance loses that coverage or if a person becomes a new dependent through marriage, birth, adoption or placement for adoption. However, you must notify the plan of your request for special enrollment within 30 days after losing your other coverage or within 30 days of having (or becoming) a new dependent.

If you enroll as a special enrollee, you may not be treated as a late enrollee for purposes of any preexisting condition exclusion period. Therefore, the maximum preexisting condition exclusion period that may be applied is 12 months, reduced by your creditable coverage (rather than 18 months, reduced by creditable coverage).

Thanks for pointing me to the right website.

Nae