Losing Group Health Insurance in Virginia

There are a number of situations that may result in losing group health insurance or managed care coverage. Generally, when this happens, there are options to continue or convert your group insurance coverage:

COBRA

Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), group health plans sponsored by employers with 20 or more employees are required to offer continuation of coverage for you and your dependents for at least 18 months. This period may be extended, depending upon the qualifying event causing the group coverage to end. If you wish to continue your group coverage under COBRA, you must notify your employer within 60 days of receiving notice of your COBRA eligibility. You must also pay the entire premium on a monthly basis, as well as an administrative fee.

WARNING: COBRA is complicated. Your employer's Human Resources office should have a booklet that explains in detail how COBRA works. This booklet may also be obtained from the Bureau of Insurance. COBRA is a federal act and the U.S. Department of Labor governs COBRA issues. Contact the Department of Labor at www.dol.gov or call 1-866-487- 2365 (TTY 1-877-889-5627).

The Centers for Medicare & Medicaid Services or "CMS", formerly known as the Health Care Financing Administration or "HCFA", has created a website for COBRA continuation of coverage as it applies to group health plans sponsored by state and local government employers (title XXII of the Public Health Service Act; 42 U.S.C. 300bb-1 through 300bb-8). The website is designed to assist qualified beneficiaries, state and local government employers and group health plan administrators in understanding their rights and responsibilities with respect to public sector COBRA continuation coverage. The website may be directly accessed at www.cms.hhs.gov/hipaa/hipaa1/cobra.

CONVERSION or CONTINUATION

Traditional group health insurance policies issued under Virginia law include either a conversion provision or a 90-day continuation period. (HMO plans must offer the conversion option, but do not have to offer a continuation option). The conversion provision states that an insured group member who is leaving the group has the right to convert to an individual health insurance policy or plan from the group insurer without presenting evidence of insurability. The conversion application for the policy has to be made to the insurer within 31 days after termination.

The continuation provision requires application for the extended coverage to be made to the group policyholder prior to termination.

The certificate of insurance issued to each person under the group policy will indicate which option is available.

There may be other options available to you as well, depending upon your individual circumstances:

• You may be able to obtain other coverage in accordance with requirements enacted to comply with the Health Insurance Portability and Accountability Act (HIPAA), (a further explanation of HIPAA follows below).
• You may consider purchasing a short-term health insurance policy if you are temporarily between jobs.
  NOTE: the purchase of this policy will negate your HIPAA-portability qualifications.
• You may secure health insurance through an association.

READ YOUR CERTIFICATE or EOC CAREFULLY to evaluate the options available to you.