Protecting Your Benefits from the U.S. DOL EBSA

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