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COBRA and HIPAA - PowerPoint PPT Presentation

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COBRA and HIPAA. What Supervisors Need to Know . Session Objectives. You will be able to: Understand the basic provisions of COBRA and HIPAA Recognize how these laws affect employees and the organization

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Presentation Transcript

Cobra and hipaa


What Supervisors Need to Know

Session objectives

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

Session outline

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

Why you need to know

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

Cobra at a glance

COBRA at a Glance

  • Continuation of health insurance coverage

  • For “qualified beneficiaries”

  • In “qualifying events”

  • For a limited amount of time

Qualified beneficiaries

Qualified Beneficiaries

  • Employees, their spouses, and dependent children

  • Deceased employees’ spouses and dependent children

Qualified beneficiaries cont

Qualified Beneficiaries (cont.)

  • Retired employees, their spouses, and dependent children

  • Others who participate in the group health plan

Qualifying events

Qualifying Events

  • Termination

  • Reduction in hours worked

  • Divorce or separation

Qualifying events cont

Qualifying Events (cont.)

  • Eligibility for Medicare

  • Death of the employee

  • FMLA is not a qualifying event



  • Identical coverage

  • Coverage for all health plans

  • Changes in coverage

Notice requirements

Notice Requirements

  • Initial notice

  • Qualifying event—notification by company

  • Qualifying event—notification by employee

  • Qualifying event—notification by plan administrator

Duration of coverage

Duration of Coverage

  • 18 months

  • 36 months in some cases

  • 29 months for disabled individuals

Duration of coverage cont

Duration of Coverage (cont.)

  • Termination of coverage

  • Conversion of coverage

Cobra premiums

COBRA Premiums

  • Cost

  • Increases

  • Payment

  • Monthly notices



  • Questions?

Hipaa at a glance

HIPAA at a Glance

  • Improves health insurance access

  • Gives employees more portable coverage

  • Limits preexisting condition exclusions

Insurance access under hipaa

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

More portable coverage

More Portable Coverage

  • Change of coverage

  • Eligibility for group plans

Preexisting conditions

Preexisting Conditions

  • What’s a preexisting condition exclusion?

  • HIPAA limitation—no more than 12 months

Preexisting conditions cont

Preexisting Conditions (cont.)

  • Reduction or elimination of exclusion

  • Eligibility for unrelated services or conditions

Creditable coverage

Creditable Coverage

  • Creditable coverage

  • Certificate of creditable coverage

Creditable coverage cont

Creditable Coverage (cont.)

  • What information should the certificate contain?

  • How do I get a certificate or correct one?

Disclosure requirements

Disclosure Requirements

  • Summary of reduction in covered services or benefits

  • Name and address of insurer

  • Sources of information and assistance about participant rights

Privacy rule

Privacy Rule

  • Limits on use and release of health records

  • Safeguards to protect personal health information (PHI)

  • More control for patients over health information

Privacy rule cont

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

Privacy rule cont1

Privacy Rule (cont.)

  • Authorization not required for PHI about:

    • Workers’ comp injuries

    • Medical surveillance or exams required by OSHA

Key points to remember

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

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