Medical Options Due to Job Change…Protect Your Rights

Opportunities and setbacks coexist in life, especially at work. Learn how changes in employment status can affect health insurance. Whether you’re looking to change employers, get a new job, lost your job, or just retired, learn today how you can get the health care benefits you may need in the future.

Know your rights and exercise your choices.

your first job

Have you just started your first job? Consider enrolling in an employer’s health plan? Learn how employer plans work and the eligibility requirements you need to meet. Your new employer must provide you with a notice of your health insurance options. If your employer offers multiple options, such as an HMO , a preferred provider option, and a high-deductible health plan, you should compare each option to your needs and preferences before making a decision. You can get more details by requesting copies of two key documents – the Summary Plan Description ( SPD ) and the Summary of Benefits and Coverage ( SBC ) . This includes your coverage benefits, the premiums and fees you will pay, and who you can contact if you have questions.

Another option to consider is enrolling through the Health Insurance Marketplace® ( “Marketplace”). The health insurance plans available in the marketplace offer comprehensive medical coverage, and you can compare prices and benefit information. Keep in mind that with most job-based health insurance plans, your employer pays part of your premiums. If you choose a market plan, your employer usually won’t pay your premiums.

unemployment

What happens if your health insurance ends because you lose your job, your employer reduces your hours, or you are laid off? Know your rights in advance to prevent your medical insurance from being terminated due to the above situations.

• Under the Health Insurance Portability and Accountability Act ( HIPAA ) , you may be eligible to enroll in your spouse’s health plan without waiting for an enrollment period. If you are considering special enrollment, you must apply for coverage within 30 days of losing eligibility for coverage.
• Under the Consolidated Omnibus Budget Reconciliation Act ( COBRA ), you, your spouse , and your dependent children may be eligible to purchase extended health insurance for up to 18 months. You may be required to pay the full premium plus a 2% administration fee.
• Under the Affordable Care Act ( ACA ) , you can purchase individual insurance through the marketplace. To do this, you must choose a plan within 60 days before or after losing your employer’s health coverage.
• Contact your state to find out if you or your dependents qualify for public health insurance such as Medicaid or the state Children’s Health Insurance Program.

Before you decide which insurance to choose, get information and compare your options.

Want a new job?

Before changing jobs, you should ask your prospective employer what health plans it offers and compare them to your current plan. Also, ask about the new plan’s coverage, premium amounts, and whether you can continue to see the same doctor. Before you sign up for coverage, you should find out if a new plan has a waiting period; generally speaking, the waiting period can be up to 90 days from the date you become eligible for the plan. COBRA gives you the opportunity to purchase temporary coverage from your former employer while you wait for a new job or a new health plan .

retire

If you plan to retire, you need to consider your arrangements for health insurance. While some employers continue to provide health benefits to their retired employees, this is not required for private sector employers. You can view your Project Summary Statement and any documents that have been modified. Request and review copies of all formal plan documents that outline how the plan operates and any other information about your employer’s policy on retiree health care benefits. Remember, federal law does not prevent employers from cutting or reducing health benefits unless they make a specific, legally enforceable commitment to continue providing those benefits.

If you want to retire early, consider your own arrangements for health insurance before you qualify for Medicare . Your options may include enrolling in your spouse’s employer plan, a plan in the marketplace, or choosing COBRA to temporarily extend your current employer coverage. Decide what your options are before you retire, as they all depend on your personal circumstances.

List of relevant regulations

HIPAA HIPAA allows you and your family to be specifically covered by your or your spouse’s employer health planwhen you lose coverage or experience certain life events (such as marriage, childbirth, adoption, or adoption placement) . HIPAA also protects you from health insurance discrimination based on certain health factors, such as previous medical conditions, previous claims, and genetic information.

The ACA’s protections related to work-based group health plans include:

• Extend dependent coverage to age 26,
• Exclusion of existing medical conditions is prohibited,
• Prohibit annual and lifetime limits on coverage of essential medical benefits, and
• Require group health plans and insurance companies to provide an easy-to-understand Summary of Benefits and Coverage.

The ACA also allows you to sign up for health insurance through the marketplace. If you enroll in Marketplace insurance, you may be eligible for tax credits to lower your monthly premiums and cost-sharing, thereby reducing your out-of-pocket costs in deductibles, coinsurance, and copayments. part.

COBRA If you are covered by your employer’s health plan but lose your job, have your hours reduced, or are laid off while your employer’s health plan continues, you and your dependents may qualify for COBRA ‘s group rates. Purchase temporary medical insurance. Divorce, legal separation, loss of dependent status of a child, death of a covered employee, or eligibility for Medicare may also entitle your covered spouse and dependent children to elect COBRA coverage. You must notify your program of these events. Group health plans must provide you with a written notice that you are eligible for COBRA coverage. You have 60 days from the date the notice is sent or the date your coverage ends, whichever is later, to elect COBRA . Generally speaking, COBRA covers group health plans offered by employers with 20 or more employees. If the employer has fewer than 20 employees, state law may require the plan’s insurance company to provide some continuation coverage.