COBRA and HIPAA What Supervisors Need to Know. © Business & Legal Reports, Inc. 0609 Session...

COBRA and HIPAA

What Supervisors Need to Know

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© Business & Legal Reports, Inc. 0609

Session ObjectivesYou 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• 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• 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 • Continuation of health

insurance coverage• For “qualified

beneficiaries” • In “qualifying events”• For a limited amount of

time


Qualified Beneficiaries• Employees, their

spouses, and dependent children • Deceased employees’

spouses and dependent children


Qualified Beneficiaries (cont.)

• Retired employees, their spouses, and dependent children • Others who participate

in the group health plan


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


Qualifying Events (cont.)

• Eligibility for Medicare • Death of the employee• FMLA is not a

qualifying event


Coverage • Identical coverage • Coverage for all health

plans • Changes in coverage


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

administrator


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


Duration of Coverage (cont.)

• Termination of coverage• Conversion of

coverage


COBRA Premiums • Cost • Increases• Payment • Monthly notices


COBRA• Questions?


HIPAA at a Glance • Improves health

insurance access • Gives employees more

portable coverage • Limits preexisting

condition exclusions


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 • Change of coverage • Eligibility for group

plans


Preexisting Conditions• What’s a preexisting

condition exclusion? • HIPAA limitation—no

more than 12 months


Preexisting Conditions (cont.)

• Reduction or elimination of exclusion • Eligibility for unrelated

services or conditions


Creditable Coverage • Creditable coverage • Certificate of creditable

coverage


Creditable Coverage (cont.)

•What information should the certificate contain?• How do I get a certificate or correct one?


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• 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.)

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 (cont.)

Authorization not required for PHI about:•Workers’ comp injuries•Medical surveillance or exams required by

OSHA


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

Date post:	15-Jan-2016
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