COBRA and HIPAA

1. COBRA and HIPAA What Supervisors Need to Know

2. 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

3. 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

4. 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

5. COBRA at a Glance • Continuation of health insurance coverage • For “qualified beneficiaries” • In “qualifying events” • For a limited amount of time

6. Qualified Beneficiaries • Employees, their spouses, and dependent children • Deceased employees’ spouses and dependent children

7. Qualified Beneficiaries (cont.) • Retired employees, their spouses, and dependent children • Others who participate in the group health plan

8. Qualifying Events • Termination • Reduction in hours worked • Divorce or separation

9. Qualifying Events (cont.) • Eligibility for Medicare • Death of the employee • FMLA is not a qualifying event

10. Coverage • Identical coverage • Coverage for all health plans • Changes in coverage

11. Notice Requirements • Initial notice • Qualifying event—notification by company • Qualifying event—notification by employee • Qualifying event—notification by plan administrator

12. Duration of Coverage • 18 months • 36 months in some cases • 29 months for disabled individuals

13. Duration of Coverage (cont.) • Termination of coverage • Conversion of coverage

14. COBRA Premiums • Cost • Increases • Payment • Monthly notices

15. COBRA • Questions?

16. HIPAA at a Glance • Improves health insurance access • Gives employees more portable coverage • Limits preexisting condition exclusions

17. 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

18. More Portable Coverage • Change of coverage • Eligibility for group plans

19. Preexisting Conditions • What’s a preexisting condition exclusion? • HIPAA limitation—no more than 12 months

20. Preexisting Conditions (cont.) • Reduction or elimination of exclusion • Eligibility for unrelated services or conditions

21. Creditable Coverage • Creditable coverage • Certificate of creditable coverage

22. Creditable Coverage (cont.) • What information should the certificate contain? • How do I get a certificate or correct one?

23. Disclosure Requirements • Summary of reduction in covered services or benefits • Name and address of insurer • Sources of information and assistance about participant rights

24. Privacy Rule • Limits on use and release of health records • Safeguards to protect personal health information (PHI) • More control for patients over health information

25. 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

26. Privacy Rule (cont.) • Authorization not required for PHI about: • Workers’ comp injuries • Medical surveillance or exams required by OSHA

27. 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