HEALTH CARE OPTIONS FOR DISLOCATED WORKERS Department of Workforce Development Workforce 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   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 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. Broadway P.O. Box 8961 Madison, WI or (608)  Eligibility requirements online at

Free & Low Cost Clinics Department of Health Services website  keyword search “free clinics”  Or, go to

Discount Prescription Programs Department of Health Services website  keyword search “prescription assistance” for information abut a variety of programs  Or, go to

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 Office of the Commissioner of Insurance 125 South Webster Street Madison, Wisconsin (608) or (800) (TDD) (ask for ) 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!!