9.2 Health Insurance
9.2 Health Insurance aetrahan Mon, 11/21/2022 - 14:13Many employers fail to give separated employees notice of their health insurance coverage rights. The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) amended ERISA to provide covered employees and other beneficiaries of employment-related group health care plans provided through employers with 20 or more employees with an opportunity to elect to continue coverage at group plan rates in the event of certain “qualifying events” such as job loss or reduction in hours.1 Qualified beneficiaries are entitled to exercise their rights under the statute even if they are covered under another healthcare plan. The employer is obligated to notify the plan administrator, who must then notify the employee or other beneficiary of the right to elect continuation of coverage. The employee or other beneficiary must make the election within 60 days of the qualifying event. Coverage may be continued for up to 18 months, although the statute allows for longer coverage in certain circumstances. Unfortunately, because COBRA does not require employers to continue to make whatever contribution they were making to an employee’s premiums during the period of employment, many employees can’t afford to pay for continuation of group health coverage.
Subsequent amendments have improved portability and continuity of health insurance. The Health Insurance Portability and Accountability Act of 1996 (HIPAA)2 requires insurers to cover workers who change jobs if their last employer provided insurance. The law also prohibits discrimination in coverage based on certain health status-related factors such as medical history and claims experience. Insurers of departing plan participants must also provide written certificates of coverage. The Patient Protection and Affordable Care Act of 2010 (colloquially known as “Obamacare”) added additional protections for continuation of coverage and for those with pre-existing conditions.
La. R.S. 22:1045 provides for continuing insurance for older surviving spouses after a worker spouse’s death. The surviving spouse must notify the insurer of the spouse’s exercise of the option within 90 days of the death and meet other statutory requirements.