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When people quit a job, retire, or get fired one thing may be overlooked. And that is your health plan. If you have health insurance from your place of employment and you leave your position for any reason other than GROSS NEGLIGENCE you are entitled to the COBRA health insurance plan. Employees need to keep themselves informed of the health care laws to protect themselves and their benefit rights. Reading your Health Plan booklet will help give you the basics of your benefits, and the health plan administrator at your place of employment should also be able to answer any questions you may have.
COBRA (Consolidated Omnibus Budget Reconciliation Act) was passed by Congress in 1986 and was a landmark in that it amended the Employee Retirement Income Security Act (ERISA), the Internal Revenue Code and the Public Health Service Act, making it possible to for you to keep health coverage temporarily after a loss of employment, in most instances the law states that the maximum coverage period is 18 months. But in some cases it can extend to 36 months depending on the circumstance behind the termination, and who is to receive the benefits. Please refer to you health plan coverage for you eligibility requirements.
Do not confuse COBRA with the FMLA of 1993 (The Family and Medical Leave Act) where the employer under certain circumstances must continue to offer the employee the same benefits as if they were still employed, until they either return to work or notify the employer they are not going to return. An employee who is receiving FMLA does not qualify for COBRA, COBRA may continue after the FMLA benefits cease.
Within 14 days of notification from the employer that a qualifying event occurred, the COBRA plan administrator must provided a notice to employees and family members of their election rights in person or by first class mail. The employee or beneficiaries then have 60 days to decide to keep the coverage or not. The Employee or Beneficiary may be required to pay the entire premium which can be expensive since the employer pays a portion of the coverage while the employee is employed. If you decide to elect coverage you will need to continue with your premiums as the insurance companies are not required to send you a premium notices and a lapse in payment could result in your loss of coverage and benefits. Health plans must contain in writing what benefits are offered and how to make a claim. You should receive a SPD booklet with this information, if you have not received it within 90 days of election contact the plan administrator. You must submit a claim to who ever is the designated administrator of your plan. And they have 90 days to accept or deny the claim. If the claim is denied then a written notice must be furnished to the insured so they can appeal the decision.