You may be able to get coverage that is more affordable than COBRA coverage through the Health Insurance Marketplace, which provides special enrollment periods for certain qualifying events, including loss of qualifying health coverage due to the death of a family member or when an employer stops contributing to a temporary continuation of your coverage (such as COBRA). For more information, visit https://www.healthcare.gov/coverage-outside-open- enrollment/special-enrollment-period/.
Q6: Can my employer terminate or reduce my health benefits at any time?
Employers offer health benefits on a voluntary basis. Federal law does not require employers to offer health coverage to their employees, nor does it generally prevent employers from cutting or
reducing benefits. However, employers may have to take certain steps (such as providing advance notice) before reducing health benefits. If an employer terminates your health benefits, depending on the reason for termination, you and your family may have a right to continuation coverage under COBRA, if the plan still exists or a related employer still has a plan. You may also have a contractual right to coverage if, for example, benefits are required under a collective bargaining agreement. In addition, a plan cannot deny eligibility or continued eligibility based on an individual’s health status.
Depending on your coverage, the law may restrict the plan or health insurer from making mid- year changes. In response to the COVID-19 outbreak, plans otherwise restricted from making mid-year changes may add telehealth and other remote health services, in addition to services related to diagnosis and treatment of COVID-19, mid-year and without providing 60 days’ advance notice as required under federal law. Such plans may not limit or eliminate other benefits or increase cost-sharing, to offset the costs of those services and must provide notice of the changes as soon as reasonably practicable. See Families First Coronavirus Response Act FAQs Part 42, Q9 at https://www.dol.gov/sites/dolgov/files/ebsa/about-ebsa/our- activities/resource-center/faqs/aca-part-42.pdf(setting forth non-enforcement policies for certain expansions in coverage in response to the COVID-19 outbreak).
For information on the Affordable Care Act and how it relates to employers offering health coverage, visit https://www.cms.gov/CCIIO/Programs-and-Initiatives/Employer-Initiatives/Employer- Initiatives.
Q7: I am a retiree and I receive retiree health benefits from my former employer. The company was affected by the COVID-19 outbreak. Can my retiree health benefits be terminated or changed?
Employees and retirees should know that private sector employers are not required by law to promise retiree health benefits. When employers do offer retiree health benefits, nothing in federal law prevents them from cutting or eliminating those benefits unless they have made a specific legally binding promise to maintain the benefits. The key to understanding your retiree health benefits lies in the documents governing your plan. If you have not already done so, you should obtain a copy of the Summary Plan Description (SPD) to determine the nature of the employer’s promise to you. If you do lose your retiree benefits, you may qualify for a special enrollment period to enroll in other coverage, discussed more above.
Q8: My employer did not pay the insurance premium for my group coverage. May I pay the premium to continue my coverage?
You should contact your employer to determine whether the employer intends to pay the premium. You may also wish to contact your state insurance commissioner regarding any rights you may have under state law to pay premiums directly to the insurance company or convert your health coverage to an individual policy.
3 Individuals that experience a significant reduction in health benefits may also qualify for a special enrollment period to enroll in Marketplace coverage. See www.healthcare.gov for more information.
Q9: I had COBRA coverage before the COVID-19 outbreak. The location I was sending my COBRA premium to is closed. Where do I send my premium?
Contact your employer for the information needed to continue making your COBRA premium payments. If you can’t contact your employer, you may contact one of our benefits advisors at www.askebsa.dol.gov or 1-866-444-3272.
Q10: Why is focusing on health coverage right away important when I lose eligibility for my employer’s plan?
Don’t wait too long to make a health coverage decision. Several of your best choices are only available for a limited time. Generally, you must request special enrollment in your spouse’s employer’s plan within 30 days of losing eligibility for other health coverage, and you must elect COBRA continuation coverage within 60 days of receiving the COBRA election notice. Even though the Department has extended those timeframes in the Joint Notice, you should be aware of the limited time available to exercise your healthcare coverage options. Additionally, you must apply for special enrollment in an individual health plan within 60 days of losing employer sponsored coverage, and that timeframe has not been extended.
If you still have questions about your rights or need help getting benefits, you may contact one of our benefits advisors at www.askebsa.dol.gov or 1-866-444-3272.
Q11. I was laid off because of the COVID-19 outbreak and filed for unemployment benefits. I received $600 per week of Federal Pandemic Unemployment Compensation in addition to my normal unemployment compensation. Can I use this money to pay my COBRA or other healthcare premiums?
Yes. As part of the recent COVID-19 legislation, Congress provided for an additional $600 per week of unemployment compensation (Federal Pandemic Unemployment Compensation) for states that enter into an agreement with the federal government. Federal Pandemic Unemployment Compensation ends on July 31, 2020. While the law does not require you to use this additional money to pay your health care premiums, maintaining your health care coverage is one of the most important things you can do in a pandemic.