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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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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