Cobra, HIPPA & Terminal Cancer

dharzer

I have an employee who waived our group health insurance (partially self funded)as she was covered under her husband's employer's policy. Husband now has terminal cancer(given two years). Has been advised by social worker @ hospital where he is being treated to go on permanent disabilty and pick up group health insurance with us. Spouse diagnosed with cancer within the last 60 days. Family also had break in insurance coverage from June-September 2003. Our insurance company states disability not a qualifying event, he needs to pick up COBRA from his current employer, then can come on with us when we have open enrollment. Also, with the break in coverage, there is a pre-existing exclusion for this time period?. Can anyone help me sort through this mess? Is employee/spouse and family members eligible for our plan (we are not mandated by state (Maryland)regs as we are partially self funded)?Thanks for your assistance. I don't participate much in the forum, however, I do enjoy reading up on issues and everyone's responses.

Pearce

If your employee's husband is covered by group coverage currently and he loses that coverage due to loss of eligibility for the coverage (termination of employment, reduction in hours of work) he should be offered COBRA continuation by his employer, and that loss of eligibility for coverage is a HIPAA mandated special enrollment event for his wife's (your) health plan. If he chooses to carry his own company's COBRA continuation your plan would also allow him entry under the HIPAA mandated special enrollment provisions when his COBRA coverage is exhausted. Since you have an open enrollment period, he is also able to be added to his wife's coverage at that time. Without knowing the specifics related to what you are stating is a break in coverage (waiting periods do not count as breaks) I cannot comment on how this period would effect your plan's pre-existing rules.

dharzer

The break in insurance was due to the employee changin employers last year, and the entire family was without insurance until the husband became eligible with his employer (not sure if a new employer or open enrollment for him).

lnelson

Our insurance carrier allows for ees to add dependants if the dependants lose their coverage but needs to be done within 30 days of loss of coverage and provide documentation from previous carrier.

You may want to speak to your insurance company for your plans specifications.

smaces_twin

Pearce,

Did you just say that the employee can come on the plan now and the husband will have to wait until he exhausts COBRA? He would not have to wait for the open enrollment in that case, right?

Pearce

I guess I missed that the wife was not now covered under her employer's plan.

The wife, if covered under her spouse's coverage would be eligible when she lost coverage under her husband's coverage (termination of employment or reduction of hours) to be enrolled under the HIPAA Special Enrollment Provisions in her own company's health plan. If she chose to enroll in COBRA with her husband then they would both be eligible to enroll at the END of the COBRA period.