Good Neighbor Insurance at www.gninsurance.com continues to update our clients on the new health insurance laws. There are six major coverage options for those in the US and even though some of the rules and regulations are similar for all many differences are there and it all depends on how old you are and for whom you work. Many critical details of this new insurance law will be clarified in the months and years to come.
These six major coverage options are:
(1) Individual or family coverage (private health care plans)
(2) Employee/employer group option for small businesses (typically under 50 employees)
(3) Employee/employer group option for large businesses (typically larger than 50 employees)
(4) Exchange options through the state you are residing in (fully integrated 1-1-2014 and are quasi-government and private insurance coverage combined)
(5) Medicare (which include Parts A, B, C, and D) for those 65 years onwards
(6) Full government health plans like Medicaid, CHIP, TRICARE, VA and other coverage plans as may be designated by the Department of Health and Human Services based mostly on financial criteria and/or military service.
Notice requirements
| Who sends notice? | Content required | Sent when? | DOL Model notice available? | Alternate notice available? | |
| General or initial notice | Plan administrator to covered employee and spouse | Minimum requirements | Within 90 days of commencement of coverage | Yes | SPD |
| Qualifying event notice-employer | Employer to plan administrator | Info about plan, qualifying events, and dates of events | 30 days after qualifying event | Yes | None |
| Qualifying even notice – employee | Covered employee to plan administrator | Plan must provide a reasonable written procedure | 60 days after qualifying events | No | Depends on plan procedure |
| Election notice | Plan administrator to qualified beneficiary | Minimum requirements as listed in final regulations | 14 days after notice of QE, or 44 days if employer is plan administrator | Yes | None |
| Notice of COBRA unavailability | Plan administrator to individuals who provided QE notice | Why individual is not entitled to COBRA | Same as election notice timeframe | No | None |
| Early termination notice | Plan administrator to qualified beneficiaries | Reason for, date of termination, conversion rights, if any | “As soon as practicable” after decision is made to terminate | No | None |
Election period
The Qualified Beneficiary has 60 days from the later of a) the date coverage would be lost as a result of the Qualifying Event, or b) the date the notice was provided to the Qualified Beneficiary. There have been, however, a number of court cases in which the date the Qualifying Event Notice was actually received marked the beginning of the 60-day election period.
Before rejecting an election form that may be received a few days after the 60-day election period ends, the Plan Administrator should determine whether the Qualified Beneficiary actually made the election within 60 days of the receipt of the Qualifying Event Notice. The maximum COBRA continuation period is generally measured from the date of the Qualifying Event , not the date of election. As a result, a Qualified Beneficiary who waits until the last day of the election period before choosing to elect will have his/her coverage reinstated retroactively back to the original benefits termination date.
Election without a premium payment
A Qualified Beneficiary has 45 days from the date of the election in order to make the initial premium payment. The Plan Administrator may not make the election of coverage contingent on the Qualified Beneficiary making the first premium payment at the time of election. If the Qualified Beneficiary fails to make the initial premium payment within the 45-day grace period, all COBRA continuation coverage will be terminated.
For a group health plan that provides health services such as an HMO or a walk-in clinic, a Qualified Beneficiary who has not yet elected or paid for coverage may be required to either elect and pay for continuation coverage, or pay a reasonable charge for services (but only if the Qualified Beneficiary will be reimbursed within 30 days of election and payment of continuation coverage).
Doug Gulleson loves to scuba dive overseas and makes sure he has his US health care and overseas health care, http://onlineglobalhealthinsurance.com/my-travel-guard.asp , information with him at all times when he travels Keep our blog close by you, www.gntravelinsurance.com, for continual updates on the changes with the U.S. health care system.
