If you're like many other Americans, you
count on your employer for health insurance coverage. But
what will happen to your health insurance if you stop
working or no longer qualify for benefits? Your company
might begin downsizing and lay you off. You could suffer a
serious injury and become disabled. Your spouse could
suddenly pass away, or your marriage could end in divorce.
These events can occur when you least expect them, leaving
you without health benefits if you can't get, or can't
afford, private individual health insurance.
Fortunately, there's COBRA.
A provision of the Consolidated Omnibus
Budget Reconciliation Act of 1986 (COBRA) entitles employees
and their dependents who have been covered under
employer-sponsored health insurance plans to continue their
coverage after their employment has ended or when their work
hours have been reduced. In 1996, the Health Insurance
Portability and Accountability Act (HIPAA) expanded on
COBRA. One provision of HIPAA created medical savings
accounts, experimental tax-advantaged accounts that can be
used for medical expenses.
COBRA
If you and your dependents are covered by an
employer-sponsored health insurance plan, COBRA entitles you
to continue coverage under circumstances that would
otherwise cause you to lose this benefit. As an employee,
you are entitled to COBRA coverage only if your employment
has been terminated or if your hours have been reduced.
However, your dependents may be eligible for COBRA benefits
if they are no longer entitled to employer-sponsored
benefits due to divorce, death, or in certain other
situations. Most larger employers are required to offer
COBRA coverage.
However, you can't continue your health
insurance coverage forever. You can continue your health
insurance for 18 months under COBRA if your employment has
been terminated or if your work hours have been reduced. If
you're entitled to COBRA coverage for other qualifying
reasons, you can continue your coverage for 36 months.
Keep in mind that you'll have to pay the
premium yourself for COBRA coverage--your employer is not
required to pay any part of it. However, if you're eligible
for COBRA coverage and don't have any other health
insurance, you should probably accept it. Even though you'll
pay a lot more for coverage than you did as an employee,
it's probably a lot less than you'll pay for individual
coverage.
The Health Insurance Portability and
Accountability Act of 1996
The Health Insurance Portability and Accountability Act (HIPAA)
is an extensive law that is intended to be the first major
step toward healthcare reform in the United States. Some of
its provisions may affect you. The major provisions of HIPAA
do the following:
- Allow workers to move from one employer
to another without fear of losing group health insurance
- Require health insurance companies that
serve small groups (2-50 employees) to accept every
small employer that applies for coverage
- Increase the tax deductibility of
medical insurance premiums for the self-employed
- Require health insurance plans to
provide inpatient coverage for a mother and newborn
infant for at least 48 hours after a normal birth or 96
hours after a cesarean section
HIPAA also created medical savings
accounts (MSAs), which are tax-advantaged individual savings
accounts that can be used to cover qualified medical
services. Currently, the MSA program is being run on a trial
basis. This experiment is scheduled to expire in 2001, at
which time the federal government will decide whether or not
to continue the program.
Presently, only two categories of
individuals are eligible to open MSAs. If you are an
employee (or the spouse of an employee) of a company that
employs 50 or fewer employees, you may be eligible to open
an MSA. Additionally, if you are self-employed (or married
to a self-employed individual), you may be eligible to open
an MSA.
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Please Note: The
information contained in this Web site is provided solely as a source of
general information and resource. It is a not a statement of
contract and coverage may not apply in all areas or circumstances. For a complete
description of coverages, always read the insurance policy, including
all endorsements.
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