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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
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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
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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
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COBRA at a Glance • Continuation of health
insurance coverage• For “qualified
beneficiaries” • In “qualifying events”• For a limited amount of
time
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Qualified Beneficiaries• Employees, their
spouses, and dependent children • Deceased employees’
spouses and dependent children
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Qualified Beneficiaries (cont.)
• Retired employees, their spouses, and dependent children • Others who participate
in the group health plan
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Qualifying Events • Termination • Reduction in hours worked • Divorce or separation
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Qualifying Events (cont.)
• Eligibility for Medicare • Death of the employee• FMLA is not a
qualifying event
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Coverage • Identical coverage • Coverage for all health
plans • Changes in coverage
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Notice Requirements • Initial notice • Qualifying event—notification by company• Qualifying event—notification by employee• Qualifying event—notification by plan
administrator
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Duration of Coverage • 18 months • 36 months in some cases • 29 months for disabled individuals
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Duration of Coverage (cont.)
• Termination of coverage• Conversion of
coverage
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COBRA Premiums • Cost • Increases• Payment • Monthly notices
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COBRA• Questions?
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HIPAA at a Glance • Improves health
insurance access • Gives employees more
portable coverage • Limits preexisting
condition exclusions
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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
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More Portable Coverage • Change of coverage • Eligibility for group
plans
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Preexisting Conditions• What’s a preexisting
condition exclusion? • HIPAA limitation—no
more than 12 months
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Preexisting Conditions (cont.)
• Reduction or elimination of exclusion • Eligibility for unrelated
services or conditions
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Creditable Coverage • Creditable coverage • Certificate of creditable
coverage
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Creditable Coverage (cont.)
•What information should the certificate contain?• How do I get a certificate or correct one?
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Disclosure Requirements • Summary of reduction in covered services
or benefits • Name and address of insurer • Sources of information and assistance
about participant rights
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Privacy Rule• Limits on use and
release of health records• Safeguards to protect
personal health information (PHI)• More control for
patients over health information
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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
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Privacy Rule (cont.)
Authorization not required for PHI about:•Workers’ comp injuries•Medical surveillance or exams required by
OSHA
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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