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Losing North Carolina Group Health Insurance Coverage

What Happens if I Lose My Employer Group Coverage?

When leaving an employer, continued coverage may be available through COBRA continuation, or through State continuation.

COBRA (Consolidated Omnibus Budget Reconciliation Act)

Federal COBRA Continuation law applies to employer groups covering 20 or more employees. This law generally allows eligible individuals to continue under the employer's group policy for up to 18 months, but the individual is responsible for paying the premiums. In some cases, the coverage can continue for longer than 18 months. COBRA continuation law applies to both insured and self-funded plans; however, it does not apply to church plans, plans covering less than 20 employees or plans covering federal employees. Detailed information on your rights under the federal COBRA laws can be obtained from the U.S. Department of Labor's Employee Benefits Security Administration, Atlanta Regional Office at (404) 302-3900. For a complete list of publications provided by the EBSA, call their hotline at 1-866-444-3272 or visit the U.S. Department of Labor's Web site at www.dol.gov.

State Continuation

North Carolina's State Continuation laws allow employees and dependents to continue coverage under the employer's group health plan after they terminate employment or otherwise lose eligibility. Under State Continuation guidelines, employees who terminate employment for any reason, whose hours are reduced or who lose eligible employee status may continue their basic health insurance coverage for up to 18 months. Upon termination or loss of eligible status, dependents covered by the policy will also be able to continue coverage for 18 months. Unlike COBRA, State Continuation laws do not provide for extensions of coverage beyond 18 months. In order to obtain more information about State Continuation contact the North Carolina Department of Insurance toll free at 1-800-546-5664. A "Consumer's Guide to State Continuation" is available on the Internet at www.ncdoi.com.

Conversion Policies

All insurance companies that sell group health insurance plans must offer an individual conversion policy to individuals who lose coverage under the group plan, without imposing exclusions of pre-existing conditions. Conversion policies may cost substantially more than your previous group coverage. Some people may qualify as HIPAA (Health Insurance Portability and Accountability Act) eligible individuals and also be eligible for coverage under individual conversion policies. If you find yourself having both of these options, you should carefully compare the premiums and benefits and choose the plan that best meets your needs.