COBRA
coverage is a temporary continuation of your Plan coverage when it would otherwise end because of a life event known as a "qualifying event." All new benefit-eligible employees will receive a COBRA letter outlining their rights. If the District is a notified of a qualifying event in a timely manner, you will also receive COBRA information. If you qualify and elect COBRA, you are responsible for paying all premiums and administrative fees.
A qualifying events includes losing coverage because:
·
Your hours of employment are reduced, or
·
Your employment ends for any reason other than your gross misconduct.
If you are the spouse of an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because any of a qualifying event such as:
·
Your spouse dies;
·
Your spouse's hours of employment are reduced;
·
Your spouse's employment ends for any reason other than his or her gross misconduct;
·
Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or
·
You become divorced or legally separated from your spouse.
Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because any of the following qualifying events happens:
·
The parent-employee dies;
·
The parent-employee's hours of employment are reduced;
·
The parent-employee's employment ends for any reason other than his or her gross misconduct;
·
The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
·
The parents become divorced or legally separated; or
·
The child stops being eligible for coverage under the plan as a "dependent child."
Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Domestic Partners are not eligible to receive COBRA benefits.
COBRA continuation coverage generally lasts up to 18 months. In certain specific situations coverage is extended beyond 18 months. If you have specific questions, please contact Audrey Martin at 425-408-7612.
HIPAA
amended the Employee Retirement Income Security Act (ERISA), to provide new rights and protections for participants and beneficiaries in group health plans. Understanding this amendment is important to your decisions about future health coverage. HIPAA contains protections both for health coverage offered in connection with employment (group health plans) and for individual insurance policies sold by insurance companies (individual policies).
If you find a new job that offers health coverage, or if you are eligible for coverage under a family member's employment-based plan, HIPAA includes protections for coverage under group health plans that:
-
Limit exclusions for preexisting conditions
-
Prohibit discrimination against employees and dependents based on their health status
-
Allow a special opportunity to enroll in a new plan to individuals in certain circumstances
If you choose to apply for an individual policy for yourself or your family, HIPAA includes protections for individual policies that:
Congress recognized the need for national patient record privacy standards in 1996 when they enacted the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The law included provisions designed to save money for health care businesses by encouraging electronic transactions, but it also required safeguards to protect the security and confidentiality of that information.
Special Enrollment rights under HIPAA allow for eligible employees or their dependents to apply for NSD's group health coverage. All of the following must apply for an individual to be considered under HIPAA Special Enrollment. Otherwise, the next available opportunity to enroll is during the regular Open Enrollment period from August 10 through September 10.
-
At the time coverage was declined for the individual(s), a Waiver of Insurance form was completed listing the indvidual(s) who were not being covered under NSD's group insurance plan. (Having other individual insurance coverage does not qualify as a reason for declining group health coverage. Loss of individual coverage does not qualify for Special Enrollment.)
-
The individual listed on the Waiver of Insurance form had other credible group coverage and lost it through no fault of their own.
-
A Certificate of Insurance showing dates/reason for loss of coverage is provided.
-
Enrollment requested within 30 days of losing other credible group coverage.
