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Retaining Health Benefits

Health Insurance New York – New York Health Care

Continuing your health insurance is an important option that many do not consider until they need to, or some other event impacts their life. Below are questions we answer regarding your rights, keeping your health insurance in New York, and other questions.

QWhat rights do I have to continue my health insurance?

If you work for a company with more than 20 employees, you will be eligible for COBRA continuation coverage in the event that you must leave your job. COBRA is the acronym for the Federal law passed in 1986 giving you the right to continue your health coverage when you lose your health coverage because of a “Qualifying Event.” Qualifying events include termination of employment and reduction in hours. Any NY disability lawyer will tell you that COBRA is an essential piece of the insurance puzzle.

Under COBRA, an individual who suffers a termination of employment is entitled to continued coverage for 18 months. In the event that such an individual is determined to be disabled under the Social Security Act, the continuation health coverage is for 29 months. Your health insurance company will be able to tell you your specific health coverage.

When you terminate employment, your employer is required to furnish you with a COBRA notice. The notice must inform you of your rights under COBRA and specify the monthly cost of your coverage. Under COBRA, the premium cost of the coverage is yours, even if your employer paid your premium while you were employed. The employer may in fact charge you an additional 2% over your premium charge to cover their administrative expenses.

When you receive your COBRA notice you must act quickly to retain your health coverage. COBRA gives you up to 60 days after you receive the notice to elect health coverage. If you fail to timely elect coverage, you will lose your right to coverage. Read your notice carefully and make sure that you comply with all time requirements.

In the event your employer had less than 20 employees, you are not entitled to COBRA continuation coverage. You may, however, be entitled to similar coverage under state law. Many states offer this type of continuation health coverage. It is usually described in the policy.

Check your policy. After COBRA continuation coverage ends, in many states you are able to convert your policy into an individual policy. These requirements are usually described in the policy. Check your policy. Please note that under a conversion policy the insurer is not necessarily required to charge the same premium.

QWhat do I do if my employer does not send me a COBRA notice?

Despite the fact that COBRA has been the law for over 10 years many employers still fail to furnish COBRA notices to help employees continue their health coverage. If you terminate employment and do not promptly receive a notice, write your employer a letter demanding a notice. This letter should be sent certified mail, return receipt requested, and should be addressed to the administrator of the medical plan. If a notice is not sent, the employer could be subject to statutory penalties of up to $110 per day and could be liable for your otherwise covered medical expenses.

QCan an insurer exclude my preexisting conditions?

Under a Federal law passed in 1997, no insurer or HMO may impose a preexisting condition limitation unless you had a break in coverage for 63 days or more. For instance, if you terminated health coverage under policy X as of June 30th, as long as you become covered under another policy within 63 days of such termination, the new policy cannot exclude any preexisting conditions.

For purposes of this new law, coverage under COBRA counts as continuous coverage. Therefore, you must obtain new health coverage within 63 days after the end of your COBRA continuation coverage. If you do not, a new policy can exclude preexisting conditions. Under the law, your insurer is required to give you a certificate which verifies that you were covered under their policy. This must be provided to you when your health coverage under the policy ceases.

In the event that you do have a break in health coverage, there are limitations on the nature of preexisting condition provisions. These provisions may only exclude a condition for a period of not more than 12 months. In addition, they can only exclude conditions for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period prior to your enrollment in the new policy.

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