Cobra and hipaa
This presentation is the property of its rightful owner.
Sponsored Links
1 / 27

COBRA and HIPAA PowerPoint PPT Presentation


  • 66 Views
  • Uploaded on
  • Presentation posted in: General

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

Download Presentation

COBRA and HIPAA

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Cobra and hipaa

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


Coverage

Coverage

  • 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


Cobra

COBRA

  • 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


  • Login