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Keeping Health Insurance Coverage
Continuing Your Group Health Insurance

Joanne and her three children had private health insurance through her husband’s employer. When her husband died, Joanne had no idea how she would be able to pay her family’s medical bills without her husband’s health insurance. Fortunately for Joanne, there is a law that allows her to continue her health insurance for a limited amount of time after her husband’s death.

Health Insurance Continuation
People with private health insurance are usually covered through their employer or spouse’s employer. What happens to their insurance when they become separated or widowed? What happens when employees retire, become disabled, take leave, are laid off or fired? Under Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), Public Law 99-272, you may continue group health insurance in all these circumstances.

COBRA requires employers with 20 or more workers to offer employees and their families the opportunity to continue insurance under certain instances, as long as the premiums continue to be paid. You are responsible for paying both the
employer and employee portions of the premiums. Your specific legal rights vary according to your situation.

For more information about COBRA, visit the Dept. of Labor at www.dol.gov
Call (215)861-5300, or toll free
(866) 444-3272.

Eligibility

In The Case of Divorce or Legal Separation
If you and/or your children are insured through your spouse’s employer, COBRA allows you to continue that health insurance for up to three years after the divorce or separation. Sometimes a divorce settlement will require your spouse to pay insurance premiums. However, it is in your best interest to ensure that those premiums are paid in a timely manner to avoid losing coverage.

When Your Spouse Passes Away
As in the case of divorce, you and your children may continue health insurance coverage for three years after your spouse dies, as long as all premiums are paid.

When Work Status Changes
COBRA can also apply to an employee or an employee’s spouse and dependent children when work is lost because the employee: retired, took leave, reduced her/his number of working hours, went on strike, was laid-off or was fired. Exceptions may be made in cases of gross misconduct. In these cases, workers, spouses and dependent children may continue group health insurance for up to a year and a half. If the employee dies, divorces or becomes eligible for Medicare during those initial 18 months, the spouse and dependents can continue coverage for a total of 36 months.

When A Child Is Insured Through a Parent
A child who has been covered under a parent’s insurance may sometimes become ineligible to remain covered under that insurance. This may happen because the child gets married, becomes a college student, or reaches an age that disqualifies the child from eligibility under the plan. When these events occur, coverage may be continued for up to three years. Be sure to find out when children are no longer considered “dependent” under the health plan.

If You Become Disabled
Workers who become disabled may lose their employment or experience a reduction in working hours. These workers can continue health insurance for up to 29 months, if they meet two eligibility requirements. (After 29 months, disabled persons are eligible for Medicare benefits).

First, the Social Security Administration must rule that he or she became disabled within the first 60 days of COBRA continuation coverage. Second, the worker needs to send the health care provider a copy of the Social Security Administration ruling letter within 60 days of receipt but prior to the expiration of the 18-month period of coverage. If these requirements are met, the entire family qualifies for an additional 11 months of COBRA continuation coverage. Health care providers may charge 150% of the premium cost after the 18th month. However, this often is still more affordable than individual insurance.

How To Continue Your Health Insurance
If you become divorced, legally separated, or a dependent child becomes ineligible for coverage, you must inform your group plan within 60 days of the occurrence. The health plan will then contact you within 14 days of your option to continue coverage. You have 60 days to respond that you want to continue. There is then a 45-day grace period to pay the premiums from the time coverage ceased.

In all other cases, such as changing jobs, the employer must notify the health plan within 30 days that an event has occurred that qualifies for COBRA health continuation. The plan will notify you within 14 days of your opportunity to continue coverage.

If you request it, employers must provide you with a copy of your health plan and a summary of your benefits.

In order to continue your group health insurance, you must continue to pay both the employer and employee portions of the monthly premiums.

Coverage will end if: premiums are not paid; the employer ends group health insurance for all employees; or you become covered by Medicare or other group insurance that covers you without limitations based on pre-existing conditions.

This tip sheet is designed to provide you with general information on health insurance continuation. It is not intended to provide legal advice. If you need legal aid, or more information on the issue, try contacting one of the following agencies.

Additional Resources

• For legal assistance, call your local legal aid center, usually under “legal aid,” “legal assistance,” or “legal services” in the phone book. Or you can call or write the National Health Law Program, 2639 South La Cienega Blvd, Los Angeles, CA 90034, (310) 204-6010, www.healthlaw.org for your local legal aid office.
  
  
• The Older Women’s League has advocated for group health continuation since its founding in 1980. It is the first national organization to focus solely on the concerns of mid-life and older women. Contact the League by writing 1750 New York Ave. NW, Suite 350 , Washington, DC 20006, calling (800)825-3695 or visiting the following address: www.owl-national.org.
  
  
• The National Women’s Health Information Center has information about women’s health issues. If you need information on a specific health issue, visit their web site at www.4women.gov or call 1(800) 994-WOMAN, Monday through Friday, 9am - 6 pm EST.
  
  
• The Black Women’s Health Imperative advocates on a variety of women’s health issues. They are located at 600 Pennsylvania Ave., SE, Suite 310, Washington, DC 20003. Call (202) 548-4000, or visit:www.blackwomenshealth.org
  

Tip sheet last updated 05/05