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Protecting Your
Employee Benefits
U.S. Department of Labor
Employee Benefits Security
Administration
Who are we and why are
we here?
 U.S. DOL, EBSA enforces
ERISA
 ERISA is the law that governs
many of the benefits sponsored
by private sector employers
 Job Loss affects benefits
 Timely action needed to protect
benefits
Health Insurance Options
 HIPAA Special
Enrollment
 COBRA
 Young Adult Coverage
 Marketplace
HIPAA
 HIPAA
 Preexisting condition exclusions
are now prohibited effective
January 1, 2014
 Certificate of creditable coverage
no longer necessary, but will be
issued until December 31, 2014
 Waiting periods not to exceed 90
days
HIPAA Special Enrollment
 Requires a group health plan to allow
an employee/spouse/dependent to
enroll for coverage upon loss of other
group health coverage
 Employee must request special
enrollment from the other plan within
30 days of loss of coverage
 Coverage takes effect by 1st of the
Month following the request to enroll
COBRA
 Ability to continue group health
coverage under employer’s plan
 Includes dental and vision plans
 Excludes disability and life
insurance plans
 Applies to plans in private and
public sectors
 Covers plans if employer has 20
or more employees
COBRA
 Job Loss – COBRA available for 18
months
 Participant can be charged up to
102% of the full cost of the
insurance.
 Notice to the Participant within 44
days
 Participant has 60 days to elect
COBRA and then 45 days to make
initial payment
 COBRA coverage is always
retroactive to date that active
employee coverage was terminated
Young Adult Coverage
 If a plan covers dependents, you
may be added to or kept on a
parent's health insurance policy
until age 26
 Adult children may be enrolled
during a plan’s open enrollment
period or under special
enrollment circumstances
Other Options
 Health Insurance Marketplace
 CHIP-Children’s Health
Insurance Program
 Medicaid
Health Insurance Marketplace
 A new way to find quality health coverage
 Several ways to apply: online, by mail, by
phone, or in person
 Healthcare.gov or call (800) 318-2596
 Apply during open enrollment, period for
2015 runs from November 15, 2014
through February 15, 2015
 Outside of open enrollment, you can enroll
if you have a qualifying life event
 The Marketplace will tell you if you qualify
for free or low-cost coverage available
through Medicaid or CHIP
Replacing COBRA with
Marketplace coverage
 Can ONLY be done during Marketplace
open enrollment, even if COBRA coverage
hasn’t run out
 If you end your COBRA coverage and
apply for a Marketplace plan during open
enrollment, you may qualify for tax credits
that can lower your monthly premiums and
lower out-of-pocket costs
 If you end your COBRA coverage early
outside of Marketplace open enrollment
you will NOT be able to enroll in a
Marketplace plan until the next open
enrollment.
Medicaid
 Free or low-cost care based on
income and family size
 You can apply for and enroll in
Medicaid any time of the year
 If you qualify, your coverage can
begin immediately
Children’s Health
Insurance Program (CHIP)
 Low-cost health coverage for
families with income above the
limit for Medicaid
 Covers parents and pregnant
women in addition to children
 Each state program has its own
rules/qualifying guidelines
 www.insurekidsnow.gov or
(877) 543-7669
Retirement Plan
 Keep plan informed of your
address
 Make sure you are getting
information from the plan at
least annually
 Benefit Payment Rules
 Age 65
 Some other time specified by the
plan
What options do I have regarding
my Retirement Benefits?
 Keep the funds in the old
plan (and keep in touch)
 Benefit Payments
 Rollovers to-
 Personal IRAs
 New Employer’s plan (if
allowed)
Direct Distributions
Contact Information
 EBSA Benefits Advisors
 1-866-444-3272 toll free
 EBSA Website for More
Information
 www.dol.gov/ebsa
 Look for Brochure entitled,
“Retirement and Health Care
Coverage…Questions and Answers
for Dislocated Workers” in English
and Spanish

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Protecting Your Benefits from the U.S. DOL EBSA

  • 1. Protecting Your Employee Benefits U.S. Department of Labor Employee Benefits Security Administration
  • 2. Who are we and why are we here?  U.S. DOL, EBSA enforces ERISA  ERISA is the law that governs many of the benefits sponsored by private sector employers  Job Loss affects benefits  Timely action needed to protect benefits
  • 3. Health Insurance Options  HIPAA Special Enrollment  COBRA  Young Adult Coverage  Marketplace
  • 4. HIPAA  HIPAA  Preexisting condition exclusions are now prohibited effective January 1, 2014  Certificate of creditable coverage no longer necessary, but will be issued until December 31, 2014  Waiting periods not to exceed 90 days
  • 5. HIPAA Special Enrollment  Requires a group health plan to allow an employee/spouse/dependent to enroll for coverage upon loss of other group health coverage  Employee must request special enrollment from the other plan within 30 days of loss of coverage  Coverage takes effect by 1st of the Month following the request to enroll
  • 6. COBRA  Ability to continue group health coverage under employer’s plan  Includes dental and vision plans  Excludes disability and life insurance plans  Applies to plans in private and public sectors  Covers plans if employer has 20 or more employees
  • 7. COBRA  Job Loss – COBRA available for 18 months  Participant can be charged up to 102% of the full cost of the insurance.  Notice to the Participant within 44 days  Participant has 60 days to elect COBRA and then 45 days to make initial payment  COBRA coverage is always retroactive to date that active employee coverage was terminated
  • 8. Young Adult Coverage  If a plan covers dependents, you may be added to or kept on a parent's health insurance policy until age 26  Adult children may be enrolled during a plan’s open enrollment period or under special enrollment circumstances
  • 9. Other Options  Health Insurance Marketplace  CHIP-Children’s Health Insurance Program  Medicaid
  • 10. Health Insurance Marketplace  A new way to find quality health coverage  Several ways to apply: online, by mail, by phone, or in person  Healthcare.gov or call (800) 318-2596  Apply during open enrollment, period for 2015 runs from November 15, 2014 through February 15, 2015  Outside of open enrollment, you can enroll if you have a qualifying life event  The Marketplace will tell you if you qualify for free or low-cost coverage available through Medicaid or CHIP
  • 11. Replacing COBRA with Marketplace coverage  Can ONLY be done during Marketplace open enrollment, even if COBRA coverage hasn’t run out  If you end your COBRA coverage and apply for a Marketplace plan during open enrollment, you may qualify for tax credits that can lower your monthly premiums and lower out-of-pocket costs  If you end your COBRA coverage early outside of Marketplace open enrollment you will NOT be able to enroll in a Marketplace plan until the next open enrollment.
  • 12. Medicaid  Free or low-cost care based on income and family size  You can apply for and enroll in Medicaid any time of the year  If you qualify, your coverage can begin immediately
  • 13. Children’s Health Insurance Program (CHIP)  Low-cost health coverage for families with income above the limit for Medicaid  Covers parents and pregnant women in addition to children  Each state program has its own rules/qualifying guidelines  www.insurekidsnow.gov or (877) 543-7669
  • 14. Retirement Plan  Keep plan informed of your address  Make sure you are getting information from the plan at least annually  Benefit Payment Rules  Age 65  Some other time specified by the plan
  • 15. What options do I have regarding my Retirement Benefits?  Keep the funds in the old plan (and keep in touch)  Benefit Payments  Rollovers to-  Personal IRAs  New Employer’s plan (if allowed) Direct Distributions
  • 16. Contact Information  EBSA Benefits Advisors  1-866-444-3272 toll free  EBSA Website for More Information  www.dol.gov/ebsa  Look for Brochure entitled, “Retirement and Health Care Coverage…Questions and Answers for Dislocated Workers” in English and Spanish