|
State and Federal Laws
Click a law to learn more...
COBRA (Consolidated Omnibus
Budget Reconciliation Act)
ERISA (Employee Retirement Income Security Act
of 1974)
FMLA (Family and Medical Leave Act)
HIPAA (Health Insurance Portability Accountability
Act of 1996)
COBRA (Consolidated
Omnibus Budget Reconciliation Act)
What is COBRA and whom does it pertain
to?
The Consolidated Omnibus
Budget Reconciliation Act (COBRA) gives workers and their families
who lose their health benefits the right to choose to continue group
health benefits provided by their group health plan for limited
periods of time under certain circumstances such as job loss, reduction
in the hours worked, transition between jobs, death, divorce, and
other life events. Qualified individuals may be required to pay
the entire premium for coverage up to 102 percent of the cost to
the plan.
COBRA is required for group health plans
sponsored by employers with 20 or more employees.
What is a qualified Beneficiary
(referred to as the QB)?
- Any individual who, on the day before
a qualifying event, is covered under a group health plan by virtue
of being on that day either a covered employee, the spouse of
a covered employee, or a dependent child of a covered employee.
- Any child who is born to or placed
for adoption with a covered employee during a period of COBRA
continuation coverage.
Do employees have to notify me
(HR) of a qualifying event?
A covered employee or QB
is required to notify the plan administrator of a qualifying event
that is a divorce or legal separation of the covered employee or
a dependent child’s ceasing to be a dependent child under
the plan terms. Also, the notice must be provided within 60 days
after the date of the qualifying event/the date on which the QB
would lose coverage because of the qualifying event, whichever is
later.
What healthcare plans are subject
to COBRA?
- Medical plans
- Dental, vision and prescription drug
plans
- Drug and alcohol treatment programs
- Employee Assistance Plans
- On-site health care
What is the duration of COBRA continuation?
If COBRA continuation is due to termination of employment or a reduction
in hours, 18 months.
18 months may be extended to 36 months if other events (death, divorce,
legal separation, or Medicare entitlement) occur in that 18-month
period.
What is the timeline for COBRA
election?
- Employee or QB has 60 days to notify
employer or administrator_60 days
- Employer has 30 days to notify plan
administrator; administrator has 14 days to send notice_44 days
- QB has 60 days to elect COBRA from
the later of the notice date or the loss of coverage date_60 days
- QB has 45 days from the election date
to make first premium payment_45 days
- QB makes first premium payment
Back to Top
ERISA
(Employee Retirement Income Security Act of 1974)
This law sets minimum standards for pension plans
in private industries. For example, if your employer maintains a
pension plan, ERISA specifies when you must be allowed to become
a participant, how long you must work before you have a non-forfeitable
interest in your pension, how long you can be away from your job
before it could affect your benefits, and whether your spouse has
a right to a portion of your pension in the event of your death.
Most of the provisions of ERISA are effective for plan years beginning
or after January 1, 1975.
ERISA does not require any employer to establish
a pension plan. It only requires that those who establish plans
must meet certain minimum standards. The law generally does not
specify how much money a participant must be paid as a benefit.
Back to Top
FMLA
(Family and Medical Leave Act)
States that covered employers (those with
50 or more employees – see
this link...) are required to grant eligible employees up to
12 weeks of unpaid leave during a 12 month period for at least one
of the reasons listed below.
-
for the birth and care of the newborn
child of the employee;
-
for placement with the employee of
a son or daughter for adoption or foster care;
-
to care for an immediate family member
(spouse, child, or parent) with a serious health condition;
-
to take medical leave when the employee
is unable to work because of a serious health condition.
-
for a Military Caregiver
-
for a Qualifying
Exigency Leave for Service Member
Back to Top
HIPAA
(Health Insurance Portability Accountability Act of 1996)
This act provides rights and protections for
participants and beneficiaries in group health plans. It also includes
protections for coverage under group health plans that limit exclusions
for preexisting conditions; prohibit discrimination against employees
and dependents based on their health status; and allow a special
opportunity to enroll in a new plan to individuals in certain circumstances
(qualifying events). Click
here to see the Department of Labor fact sheet.
For
Frequently Asked Questions pertaining to HIPAA, please click here.
Back to Top
|
