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Protecting Your
Employee Benefits U.S. Department of Labor
Employee Benefits Security Administration
Who are we and why are
we here?
U.S. DOL, EBSA enforces
ERISA
ERISA is the law that governs
many of the benefits sponsored
by private sector employers
Job Loss affects benefits
Timely action needed to protect
benefits
Health Insurance Options
HIPAA Special
Enrollment
COBRA
Young Adult Coverage
Marketplace
HIPAA
HIPAA
Preexisting condition exclusions are now prohibited effective January 1, 2014
Certificate of creditable coverage no longer necessary, but will be issued until December 31, 2014
Waiting periods not to exceed 90 days
HIPAA Special Enrollment
Requires a group health plan to allow
an employee/spouse/dependent to
enroll for coverage upon loss of other
group health coverage
Employee must request special
enrollment from the other plan within
30 days of loss of coverage
Coverage takes effect by 1st of the
Month following the request to enroll
COBRA
Ability to continue group health
coverage under employer’s plan
Includes dental and vision plans
Excludes disability and life
insurance plans
Applies to plans in private and
public sectors
Covers plans if employer has 20
or more employees
COBRA
Job Loss – COBRA available for 18 months
Participant can be charged up to 102% of the full cost of the insurance.
Notice to the Participant within 44 days
Participant has 60 days to elect COBRA and then 45 days to make initial payment
COBRA coverage is always retroactive to date that active employee coverage was terminated
Young Adult Coverage
If a plan covers dependents, you
may be added to or kept on a
parent's health insurance policy
until age 26
Adult children may be enrolled
during a plan’s open enrollment
period or under special
enrollment circumstances
Other Options
Health Insurance Marketplace
CHIP-Children’s Health
Insurance Program
Medicaid
Health Insurance Marketplace
A new way to find quality health coverage
Several ways to apply: online, by mail, by
phone, or in person
Healthcare.gov or call (800) 318-2596
Apply during open enrollment, period for
2015 runs from November 15, 2014
through February 15, 2015
Outside of open enrollment, you can enroll
if you have a qualifying life event
The Marketplace will tell you if you qualify
for free or low-cost coverage available
through Medicaid or CHIP
Replacing COBRA with
Marketplace coverage
Can ONLY be done during Marketplace
open enrollment, even if COBRA coverage
hasn’t run out
If you end your COBRA coverage and
apply for a Marketplace plan during open
enrollment, you may qualify for tax credits
that can lower your monthly premiums and
lower out-of-pocket costs
If you end your COBRA coverage early
outside of Marketplace open enrollment
you will NOT be able to enroll in a
Marketplace plan until the next open
enrollment.
Medicaid
Free or low-cost care based on
income and family size
You can apply for and enroll in
Medicaid any time of the year
If you qualify, your coverage can
begin immediately
Children’s Health
Insurance Program (CHIP)
Low-cost health coverage for
families with income above the
limit for Medicaid
Covers parents and pregnant
women in addition to children
Each state program has its own
rules/qualifying guidelines
www.insurekidsnow.gov or
(877) 543-7669
Retirement Plan
Keep plan informed of your
address
Make sure you are getting
information from the plan at
least annually
Benefit Payment Rules
Age 65
Some other time specified by the
plan
What options do I have regarding
my Retirement Benefits?
Keep the funds in the old
plan (and keep in touch)
Benefit Payments
Rollovers to-
Personal IRAs
New Employer’s plan (if
allowed)
Direct Distributions
Contact Information
EBSA Benefits Advisors
1-866-444-3272 toll free
EBSA Website for More Information
www.dol.gov/ebsa
Look for Brochure entitled, “Retirement and Health Care Coverage…Questions and Answers for Dislocated Workers” in English and Spanish
