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.