WORK
CHANGES
REQUIRE HEALTH
CHOICES
PROTECT YOUR RIGHTS
EMPLOYEE BENEFITS SECURITY ADMINISTRATION
UNITED STATES DEPARTMENT OF LABOR
Work Changes
Require Health
Choices... Protect
Your Rights
Opportunities and
setbacks are part of life
- especially when it
comes to work. Learn
how changes in
employment status can affect health
coverage. Whether you are thinking about
changing employers, have landed a new job,
or lost or retired from one, find out today
how to have the health benefits you might
need tomorrow. Know your rights. Exercise
your options.
Your First Job
Starting your very first job? Your new
employer should provide you with a notice of your
health coverage options. Consider enrolling in
your employers health care plan. If your employer
offers more than one option an HMO plan, a
preferred provider option, and a fee-for-service
plan, for example compare each to your needs
and preferences before making a decision. Ask
for copies of two key documents the Summary
Plan Description (SPD) and the Summary of
Benefits and Coverage (SBC) to get details about
covered benefits and costs. Find out what type of
plan you have, how it works, and what eligibility
requirements you may have to meet. Know what
portion of your premium and costs you will pay,
how much they will be, and who to talk to if you
have questions.
Another option to consider is enrolling in coverage
through the Health Insurance Marketplace
(Marketplace). The Marketplace offers health
insurance plans that provide comprehensive
health coverage that present their price and
benefit information in an SBC so you can make
comparisons. Keep in mind that with most jobbased health insurance plans, your employer pays
part of your premiums. If you pick a Marketplace
plan instead, the employer usually doesnt
contribute to your premiums.
Job Loss
What if your health care coverage ends
because you lose your job, have your hours reduced,
or get laid off ? Knowing your rights ahead of time can
prevent these situations from meaning an end to health
care coverage. Under the Health Insurance Portability
and Accountability Act (HIPAA), you may be eligible
to enroll in your spouses health plan without waiting
for an open enrollment period. Under the Patient
Protection and Affordable Care Act (ACA), you can
buy individual insurance coverage through the Health
Insurance Marketplace. For other employment-based
coverage (such as a spouses plan), you must request
enrollment within 30 days of your loss of coverage.
For Marketplace coverage, you must select a plan
either within 60 days before losing coverage or within
60 days after losing coverage. You, your spouse, and
your dependent children also might be able to purchase
extended health coverage for up to 18 months under
the Consolidated Omnibus Budget Reconciliation Act
(COBRA). You may have to pay the entire premium
plus a 2 percent administrative fee. Also, contact your
state government to find out if you or your dependents
are eligible for public health insurance, like Medicaid
or the state Childrens Health Insurance Program.
Get information and compare your options before
you decide which coverage to elect.
Looking for a New Job?
Before switching jobs, ask about the type
of health plan offered by the potential employer
and compare it to your current plan. Ask about the
premium youll pay under the new plan, what it covers,
whether you can continue with the same doctors, or
whether you will have to see new ones. Check to see
if your potential employers plan has a waiting period
before you can enroll in coverage generally, it may
last up to 90 days from the date you become eligible
for the plan. COBRA may give you the opportunity
to purchase temporary extended health care benefits
offered by your former employer while you are looking
for a new job or during a waiting period for health
benefits imposed by your new employer.
Retirement
When youre thinking about retiring,
be sure you understand the documents governing
your health care plan. Review your SPD and any
documents you have received that modify it. Also,
request copies of any formal written documents
that outline how your plan operates, and any other
information on your employers policies on retiree
health care benefits. Realize that although some
employers continue to provide health care benefits to
their retired employees, private-sector employers are
not required to provide retiree health benefits. And
remember, Federal law does not prevent employers
from cutting or reducing health benefits under plans
available to participants and their families, unless
there has been a specific promise to continue them
and that promise can be legally enforced.
If you want to retire early, consider what you will
do for health coverage before you are eligible for
Medicare. Your options may include enrolling in a
spouses employer plan or in a Marketplace plan or
temporarily continuing your employer coverage by
electing COBRA. Your rights to these options will
depend on your individual circumstances, so find out
what your options are before you retire.
At a Glance
HIPAA
HIPAA allows you and your family members to
special enroll in your employer-sponsored health
plan or your spouses when you lose other coverage
or experience certain life events such as marriage,
birth, adoption or placement for adoption.
HIPAA also protects you against discrimination
in health coverage based on certain health factors
such as prior medical conditions, previous claims
experience, and genetic information.
ACA
The ACA protections related to employment-based
group health plans include extending dependent
coverage until age 26, prohibiting preexisting
condition exclusions, banning annual and lifetime
limits on coverage for essential health benefits,
and requiring group health plans and insurers
to provide an easy-to-understand summary of
a health plans benefits and coverage. The ACA
also allows you to enroll in health coverage through
the Health Insurance Marketplace. If you enroll
in Marketplace coverage, you may be eligible for
a tax credit that will lower your monthly premiums
and cost-sharing reductions that will lower your
out-of-pocket costs for deductibles, coinsurance
and copayments.
COBRA
If you are covered under your employers health
plan and you lose your job, have your hours
reduced, or get laid off, and your employers health
plan continues to exist, you and your dependents
may qualify to purchase temporary extended health
coverage at group rates under COBRA. Divorce,
legal separation, loss of dependent child status,
the covered employees death, or entitlement to
Medicare may also give your covered spouse and
dependent children the right to elect continued
coverage under COBRA. Your plan must be
notified of these events. Generally, COBRA covers
group health plans maintained by employers with
20 or more employees. The group health plan
is required to provide you with a written notice
indicating your eligibility for COBRA coverage. If
you are eligible, you will have 60 days from the date
the notice is sent or from the date your coverage
ends whichever is later to elect COBRA. If
the employer is too small to be subject to COBRA,
state law may require the plans insurer to provide
some continuation coverage.
For More Information:
The Department of Labors Employee Benefits Security
Administration (EBSA) administers several important
health benefit laws covering employer-provided health
plans and your basic rights to information on how your
health plan works, how you qualify for benefits, and how
to make claims for benefits. In addition, there are specific
laws protecting your right to health benefits when you
lose coverage or change jobs.
Visit the Employee Benefits Security Administrations
Website at dol.gov/ebsa to view the following
publications. To order copies or to request assistance
from a benefits advisor, contact EBSA electronically at
askebsa.dol.gov or call toll free 1-866-444-3272.
Retirement and Health Care CoverageQuestions
and Answers for Dislocated Workers
An Employees Guide to Health Benefits Under COBRA
Your Health Plan and You Know Your Health
Coverage Protections
Can the Retiree Health Benefits Provided by Your
Employer Be Cut?
Top 10 Ways to Make Your Health Benefits Work for You
Life Changes Require Health ChoicesKnow Your
Benefit Options
Taking the Mystery Out of Retirement Planning
You also may visit the U.S. Department of Health and
Human Services Website at HealthCare.gov or call
1-800-318-2596 to find out more about Marketplace
plans. Or contact your state insurance commissioners
office.
EMPLOYEE BENEFITS SECURITY ADMINISTRATION
UNITED STATES DEPARTMENT OF LABOR
December 2014
