HEALTH CARE OPTIONS FOR DISLOCATED

WORKERS

Department of Workforce DevelopmentWorkforce Programs Roundtable, May 18, 2010

Presenters

Gesina Mentink, State Rapid Response Coordinator, Department of Workforce Development

Jodie Mender, Department of Health Services

What is a “Dislocated Worker?”

Someone who loses his or her job through no fault of his or her own

Possible Health Insurance Options:

COBRA and “mini-COBRA” Special enrollment BadgerCare programs Private individual insurance policy WI Health Insurance Risk Sharing Plan (HIRSP) Free or low cost clinics Discount prescription programs The Health Coverage Tax Credit (HCTC)

Consolidated Omnibus Budget Reconciliation Act (COBRA) Federal law giving workers the right to continue their

group health plans for a limited time after losing their coverage due to a “qualifying event”

Establishes minimum requirements for continuation coverage

Generally applies to all group health plans maintained by employers with at least 20 employees

It is a continuation of a person’s insurance plan . . . not a new plan

COBRA

What is a “qualifying event?”

An event that causes a person to lose his or her group health coverage

Examples: Termination of employment for any reason other than “gross

misconduct” Reduction of hours of employment Bankruptcy of the employer

COBRA

What types of group policies can be continued through COBRA?

Group health plans providing medical care

Includes plans for prescription drugs, dental care, and vision care

Excludes plans that only provide life insurance or disability benefits

COBRA What is the process?

A covered employee loses coverage due to qualifying event

Employer must notify the insurance provider / plan administrator of the qualifying event within 30 days

The insurance provider / plan administrator has 14 days to provide the “Election Notice” to qualified beneficiaries

The Election Notice should provide all premium information

Person has 60 days from the date the Notice is received or coverage is lost, whichever is later, to complete & return the form

Person must make an initial premium payment within 45 days after the date you mail in your election form

COBRA

When does coverage begin? Once you elect COBRA and pay for it, your continuation

coverage begins on the date that your coverage through your employer ceased

Beware of retroactive premiums!

How long will coverage last? Generally 18 months where the qualifying event is a termination

of employment

COBRA

Reasons a person may lose COBRA…

Failure to make timely premium payments 30-day grace period for payment of any premium Insurance provider / administrator is not required to send monthly premium

invoices

Employer discontinues the group health plan altogether Possible exception – Wisconsin’s Emergency Rule through the Office of the

Commissioner of Insurance (OCI)

Become insured under another group health plan (spouse’s plan or new employer’s plan) or Medicare

COBRA

What will it cost? What you paid before + employer’s contribution (+ possible 2%

administration fee)

Unless you are eligible for the COBRA premium subsidy under the American Recovery & Reinvestment Act of 2009 (ARRA) as amended by the Department of Defense Appropriations Act of 2010 (DOD) and the Temporary Extension Act of 2010 (TEA).

COBRA

What is the COBRA premium subsidy? Provides a premium reduction for up to 15 months for eligible individuals Individual responsible for only 35% of monthly premium Applies to all group health plans, including health, dental, & vision

Who is eligible for the subsidy? Involuntary termination between Sept. 1, 2008 to May 31, 2010 Qualified beneficiary who elects coverage Not eligible for other group health coverage or Medicare Income restrictions

COBRA

Other important points

“Independent rights” of qualified beneficiaries

COBRA is tied to the “active” plan Any changes made to the plan’s terms that apply to active

employees and their family members also apply to persons receiving COBRA continuation insurance

COBRA

Dept. of Labor, EBSA http://www.dol.gov/ebsa 1-866-444-EBSA (3272)

HIPAA

Health Insurance Portability & Accountability Act (HIPAA) of 1996

Provides an with various protections Allows for “special enrollment” Limits pre-existing condition exclusion periods Prohibits discrimination based on health factors Guarantees access to individual health insurance

policies in certain situations

HIPAA

What are pre-existing conditions? Any medical condition for which a person treated in the 6 months before enrolling in a new

group plan Some exceptions, including pregnancy

What are exclusionary periods? Period of time where any treatment for a pre-existing condition will not be covered by the

new group plan Generally, the max length is 12 months after one’s enrollment date

How does someone reduce or eliminate an exclusionary period?

Showing proof of “Creditable Coverage” Continuous health insurance in the last 12 months without a “significant break” (i.e. more

than 63 days) Certificate of Creditable Coverage

Special Enrollment

What is it? Allows you, spouse, and dependents (if covered by former employer’s group

health plan) to enroll in a group health plan offered by your spouse’s employer

Independent rights

Enrollment must be requested no later than 30 days after your coverage ended

Coverage begins the first day of the month after enrollment

Want more information? Dept. of Labor, EBSA

http://www.dol.gov/ebsa 1-866-444-EBSA (3272)

BadgerCare Programs

Private Individual Insurance

Contact local health insurance agents for quotes

Anybody can do this, but HIPAA guarantees access to individuals who have lost coverage under a group health plan

Certain criteria must be met including that the individual is either not eligible for COBRA or has exhausted COBRA benefits

Extent of coverage and rates vary by plan

WI Health Insurance Risk Sharing Plan (HIRSP) If you are unable to get an adequate private policy

because of a medical condition contact:

The Wisconsin Health Insurance Risk Sharing Plan (HIRSP) HIRSP

1751 W. BroadwayP.O. Box 8961Madison, WI 53708-8961800-828-4777 or(608) 221-4551

Eligibility requirements online at http://www.hirsp.org/

Free & Low Cost Clinics

Department of Health Services website http://dhs.wi.gov/, keyword search “free clinics” Or, go to http://dhs.wisconsin.gov/forwardhealth/clinics.htm

Discount Prescription Programs

Department of Health Services website http://dhs.wi.gov/, keyword search “prescription assistance” for

information abut a variety of programs Or, go to http://dhs.wisconsin.gov/guide/spec/freeprescr.htm

Under 27 years old?

Recently enacted statute provides that individuals under 27 years of age may be eligible for coverage under their parents’ group health insurance plan, Wis. Stats. 632.885

Office of the Commissioner of Insurance125 South Webster StreetMadison, Wisconsin 53703-3474(608) 266-3585 or (800) 236-8517711 (TDD) (ask for 608-266-3586)Hours: Monday - Friday 7:45 a.m. - 4:30 p.m. (except for legal holidays)

Health Coverage Tax Credit (HCTC)

What is it? Federal tax credit program administered by IRS as part of the

Trade Adjustment Assistance Reform Act (2002)

What is its purpose? Help cover the cost of health care for workers who have lost

their jobs due to foreign trade or who are receiving pension payments from the Pension Benefit Guaranty Corporation (PBGC)

Qualified family members may also receive the tax credit

THANKS!!