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COBRA and HIPAA What Supervisors Need to Know
© Business & Legal Reports, Inc Session Objectives You will be able to: Understand the basic provisions of COBRA and HIPAA Recognize how these laws affect employees and the organization Provide employees with information about access to health coverage under these laws
© Business & Legal Reports, Inc Session Outline Qualified beneficiaries and qualifying events under COBRA COBRA notice requirements Duration of coverage and COBRA premiums Access to and portability of coverage under HIPAA Preexisting conditions under HIPAA HIPAA Privacy Rule
© Business & Legal Reports, Inc Why You Need to Know COBRA and HIPAA affect an important employee benefit—health insurance You need to be able to answer employees’ questions and help them access benefits Provisions of COBRA and HIPAA may also affect you and your family
© Business & Legal Reports, Inc COBRA at a Glance Continuation of health insurance coverage For “qualified beneficiaries” In “qualifying events” For a limited amount of time
© Business & Legal Reports, Inc Qualified Beneficiaries Employees, their spouses, and dependent children Deceased employees’ spouses and dependent children
© Business & Legal Reports, Inc Qualified Beneficiaries (cont.) Retired employees, their spouses, and dependent children Others who participate in the group health plan
© Business & Legal Reports, Inc Qualifying Events Termination Reduction in hours worked Divorce or separation
© Business & Legal Reports, Inc Qualifying Events (cont.) Eligibility for Medicare Death of the employee FMLA is not a qualifying event
© Business & Legal Reports, Inc Coverage Identical coverage Coverage for all health plans Changes in coverage
© Business & Legal Reports, Inc Notice Requirements Initial notice Qualifying event—notification by company Qualifying event—notification by employee Qualifying event—notification by plan administrator
© Business & Legal Reports, Inc Duration of Coverage 18 months 36 months in some cases 29 months for disabled individuals
© Business & Legal Reports, Inc Duration of Coverage (cont.) Termination of coverage Conversion of coverage
© Business & Legal Reports, Inc COBRA Premiums Cost Increases Payment Monthly notices
© Business & Legal Reports, Inc COBRA Questions?
© Business & Legal Reports, Inc HIPAA at a Glance Improves health insurance access Gives employees more portable coverage Limits preexisting condition exclusions
© Business & Legal Reports, Inc Insurance Access Under HIPAA Access to coverage by small companies Renewal of coverage for all companies Denial of coverage Premiums Benefit coverage limitations or restrictions
© Business & Legal Reports, Inc More Portable Coverage Change of coverage Eligibility for group plans
© Business & Legal Reports, Inc Preexisting Conditions What’s a preexisting condition exclusion? HIPAA limitation—no more than 12 months
© Business & Legal Reports, Inc Preexisting Conditions (cont.) Reduction or elimination of exclusion Eligibility for unrelated services or conditions
© Business & Legal Reports, Inc Creditable Coverage Creditable coverage Certificate of creditable coverage
© Business & Legal Reports, Inc Creditable Coverage (cont.) What information should the certificate contain? How do I get a certificate or correct one?
© Business & Legal Reports, Inc Disclosure Requirements Summary of reduction in covered services or benefits Name and address of insurer Sources of information and assistance about participant rights
© Business & Legal Reports, Inc Privacy Rule Limits on use and release of health records Safeguards to protect personal health information (PHI) More control for patients over health information
© Business & Legal Reports, Inc Privacy Rule (cont.) Authorization required for PHI relevant to: ADA or FMLA leave Verification of illness Return to work/modification of duties Preemployment physicals and drug tests Treatment from EAP or outside providers
© Business & Legal Reports, Inc Privacy Rule (cont.) Authorization not required for PHI about: Workers’ comp injuries Medical surveillance or exams required by OSHA
© Business & Legal Reports, Inc Key Points to Remember COBRA provides continuation of health insurance for employees, former employees, and their families HIPAA improves insurance access, makes it easier to begin coverage, and ensures greater privacy for medical information
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