HIPAA - SAMPLE NOTICE TO COBRA BENEFICIARIES (To be sent by November 1, 1996)
The Health Insurance Portability and Accountability Act of 1996 made important changes in COBRA continuation coverage rules that will take effect on January 1, 1997. A comparison of the current rules and the rules that will become effective on January 1, 1997, is provided below. Please review these changes carefully as they may have an effect on your continuation coverage.
Extension of Coverage for Disabled Beneficiaries
A qualified beneficiary may be eligible for an extension of up to 11 months of COBRA continuation coverage due to disability, if the Plan Administrator receives notification of the Social Security Administration's determination of disability, in writing, within 60 days of the date the determination is made and within the initial 18 months of COBRA continuation coverage.
Currently, only COBRA beneficiaries determined by the Social Security Administration to have been totally disabled on the date of the qualifying event (i.e., the employee's termination of employment, or reduction in hours) making that individual eligible to elect COBRA coverage were eligible to extend continuation coverage for an additional 11 months, to a maximum of 29 months of COBRA continuation coverage.
Effective on January 1, 1997, an extension of up to 11 months of continuation coverage will be available to a qualified beneficiary who is totally disabled during the first 60 days after COBRA continuation coverage begins. Note: the new rule applies to those whose COBRA coverage began in 1996 who are still covered on January 1, 1997, as well as those who become eligible for COBRA in 1997.
Coverage for Newborns & Children Placed for Adoption
Newborn infants and children placed for adoption can be enrolled for COBRA continuation coverage in accordance with the terms of the [name of plan] group health plan. A child is considered to be placed for adoption when the adoptive parent assumes and retains the legal obligation for the support of the child, in accordance with an order to that effect issued by a proper court or other agency which has the authority to issue such order.
Under the current rules, a newborn infant or a child placed for adoption could be enrolled for COBRA continuation coverage; however, the infant or adopted child would not have independent rights as a COBRA beneficiary.
Effective on January 1, 1997, a newborn infant or child placed for adoption with the covered employee will be entitled to receive COBRA continuation coverage as a qualified beneficiary. To enroll a newborn or a child placed with you for adoption, you must notify the Plan Administrator within (plan's time limit for enrolling newly eligible dependent, e.g. 30 days) of your newborn's date or birth or (repeat the plan's time limit) of the date a child is placed with you for adoption. Note: if you added a dependent child during your first 18 months of COBRA continuation coverage and you are covered under COBRA on January 1, 1997, that child will become a qualified beneficiary on January 1, 1997.