Maintaining Health Insurance

Maintaining health insurance is extremely important to people with chronic conditions or diseases such as MS. Many express fear that leaving the workforce or changing from full-time to part-time employment will result in loss of health coverage, not only for themselves but for their families.

Concern is also expressed that people who change jobs may not be able to get health insurance coverage from their new employer because of their pre-existing condition.

Two pieces of federal legislation provide important protections to people with MS who have employment-related concerns about health insurance coverage.

Continuation Coverage (COBRA) The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 applies to all companies with 20 or more employees. When an individual leaves a job for any reason other than gross misconduct, or converts from full-time to part-time employment, she must be given the opportunity to purchase continued health coverage under the employer plan for an additional 18 months at the group rate. The employer no longer must contribute to the plan, however, so the employee must pay for the full cost of coverage. Although this option can be expensive, it is important to remember that employer group plans are generally more comprehensive and less costly than insurance in the individual market.

If a person purchases COBRA coverage and it is determined that he/she has a disability according to the Social Security Administration, the length of time for continuation of coverage can be extended to 29 months. COBRA also requires employers to offer continuation coverage, up to 36 months, in the event of divorce, separation, a child leaving dependent status, or the death of an employee.

If a person is employed by a company with less than 20 employees and is not covered by this COBRA legislation, many states have passed mini-COBRA laws that can provide similar protections, though usually less extensive.

Protections Regarding Pre-Existing Conditions (HIPAA)

The Health Insurance Portability and Accountability Act (HIPAA) was passed by Congress in 1996 to protect health insurance coverage for Americans who move from one job to another or who have pre-existing medical conditions. Employer plans must cover all employees, regardless of health status. No employee can be dropped from coverage if he becomes ill. The longest an employer can delay coverage of a pre-existing condition is 1 year. Once that exclusion period is met, employees do not have to meet it again, even if they change jobs, provided they do so within 63 days. Therefore, people with pre-existing medical conditions can move from one group plan to another without jeopardizing their health insurance coverage.

HIPAA also protects those who lose group coverage, including COBRA, and must purchase an individual policy. As long as the individual has had continuous group coverage for 18 months and is not eligible for another group plan, Medicare, or

Medicaid, he is guaranteed access to the individual market.

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