Health Benefits

Q & A on Small Business Health Care Tax Credit

Training Opportunities:

9/20  New Healthcare Reform: Focus on Employer Issues (Pittsburgh)

 9/21  New Healthcare Reform: Focus on Employer Issues (Harrisburg) 

Limited Medical Benefit Coverage
Press Release  
What's Covered  
Program Details

Information Sheets about Traditional Program:

Benefits Available
Press release from March 2009
Q & A #1 regarding the program. (posted 1-19-06)
Fax back form for enrollment information
Articles and Research on Health Insurance.

IMPORTANT NOTIFICATIONS

President Signs Into Law Temporary Extension of COBRA Premium Subsidy

On March 2, 2010, President Obama signed into law a bill to temporarily extend the COBRA premium subsidy program, along with other programs, all of which had expired on February 28. The "Temporary Extension Act of 2010" (H.R. 4691), which was passed by the Senate on March 2 and the House on February 25, extends the 65% COBRA premium subsidy included in the American Recovery and Reinvestment Act (ARRA) through March 31, 2010. In addition, the law expands eligibility for the COBRA premium subsidy to certain individuals who are involuntarily terminated after they experience a qualifying event of reduction in hours.

In a statement, the President indicated that he was "grateful to the members of the Senate on both sides of the aisle who worked to end this roadblock to relief for America's working families." The Senate is also considering a longer extension of the COBRA premium subsidy in a separate bill in the coming weeks, which would extend the program through December 31, 2010. We will continue to monitor these developments.

Please contact your JRG Advisor with any questions. The full text of the Extension Act (H.R. 4691) is available here.

Governor Rendell has signed a new bill that will affect small and large businesses. Please review this important information to learn how Act 2 of 2009 will impact your business.

On June 10, 2009 the state’s Mini COBRA legislation was signed into law. Employers who employ 2 to 19 employees are now required to offer health insurance continuation post employment and are obligated to comply with the Federal subsidy of COBRA under the American Recovery and Reinvestment Act (ARRA).

Highlights of the Mini COBRA legislation are as follows:

• Employers who employ 2 to19 employees who offer healthcare benefits must comply;
• The law was signed June 10, 2009 and went into effect July 10, 2009;
• An enrollee must have been insured through the employer for a minimum of three (3) months prior to the qualifying event;
• An enrollee must not be eligible for Medicare and not covered by other private health insurance;
• Mini COBRA qualifying events are the same as those under Federal COBRA regulations (qualifying events include termination of employment, divorce, death, ceasing to be a dependent, etc.);
• Mini COBRA benefits may continue for a maximum of nine (9) months; Employers/Administrators may charge up to 105% of the medical premium to COBRA enrollees;
• If an enrollee qualifies under the federal stimulus law, they may receive a 65% premium reduction.*

* If an enrollee is eligible for premium assistance, they are required to notify the plan when they become eligible for Medicare or other group coverage or they could be subject to a penalty of 110% of any premium assistance received.

NOTE: If an enrollee ends up earning more than $125,000 ($250,000 for a married couple filing a joint tax return) over the course of the year, any premium assistance will be recaptured by an increase in their tax liability. To avoid tax consequence, an enrollee may delay electing, or permanently waive premium assistance if they think they might earn this amount.

Health Insurance Coverage for Adult Children

Eligible children can continue to be covered under their parent’s health insurance plan beyond the age of 19. The new law allows eligible adult children to remain covered until the age of 30. Eligible adult children must meet the following criteria:

They are unmarried They have no dependents They are a resident of Pennsylvania or they are enrolled as a full-time student in an institution of higher education They are not provided with private insurance or enrolled in (or eligible for) government benefits

The law applies to new health contracts and renewals occurring 180 days (6 months) after June 10, 2009 and then on a rolling basis as contracts are made or renewed. For example, since the law was signed in June 2009, if a policy is issued or renewed in January 2010 the provisions will take effect with the January 2010 issuance or renewal.

While this coverage expansion provision must be included in all insurance contracts issued in the state of Pennsylvania, employers have the option to choose whether or not to extend the coverage to the dependents of their employees.

Please feel free to contact your JRG Advisors representative at 412-456-7000 with questions.

Michelle’s Law: New Mandate on Dependent Student Eligibility

On October 9, 2008, a new federal law was enacted that provides for continuation of dependent coverage for students who would otherwise lose eligibility because of a reduction in their full-time class status or a medically necessary leave of absence from school. The law, known as Michelle’s Law, applies to almost all group health plans (fully insured and self-insured) that cover dependents and use student status to determine eligibility.

For benefits plan years starting on or after October 9, 2009, the new law prohibits a group health plan from terminating a college student’s health coverage on the basis of the child taking a medically necessary leave of absence from school or changing to part-time status. For plans that run on a calendar-year basis, this law becomes effective January 1, 2010.

The following requirements must exist in order for this provision to apply:

The leave of absence or reduction in hours must be medically necessary and must commence while the eligible student is suffering from a serious illness or injury and would otherwise lose coverage under the plan; The student must have been enrolled in the group health plan before the first day of the leave; There must be written certification by the student’s physician indicating that the student is suffering from a serious illness or injury that necessitates the leave or change in enrollment status.

The coverage under Michelle’s Law must be extended for at least one year; however, coverage may end earlier for certain reasons (i.e. the student aging out of the plan as a result of exceeding the plan’s normal dependent-eligibility age).

There are certain questions that do not have answers as of today. For example, the law does not indicate who is responsible for paying the cost of coverage extended via Michelle’s Law. The legislation does not specifically indicate that the employer is required to absorb the additional premiums as a result of the extension of coverage. In addition, the new law does not describe how it will integrate with COBRA coverage and if the continuation can be credited toward COBRA coverage.

We will share additional information regarding Michelle’s Law as it becomes available. Please feel free to contact JRG Advisors, management company for Health Alliance for Nonprofits, at 1-800-273-6709 with any questions.

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JRG Advisors is not a COBRA administrator. However, we are prepared to assist clients in meeting the requirements. Although we do not administer Mini COBRA on behalf of our clients, we will assist with the research, implementation and coordination of a COBRA administrator.

Additional information will be communicated as it received. In the meantime, you can visit the Pennsylvania Insurance Department’s website at www.ins.state.pa.us.