Group health insurance continuation: know your rights [1993]

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Access To Health Insurance Coverage
A new state law will protect older Georgians whose employment is terminated by allowing them to continue group coverage until they are eligible for Medicare, thereby avoiding potentially devastating gaps in health insurance coverage.
Under a federal law called COORA, employers must provide employees the opportunity to continue their group coverage when they would otherwise lose it, such as when the employee retires or is laid off worl~. The length of continuation depends on the reason for the loss of employment, but most often coverage lasts a maximum of 18 months. Although the covered person, not the employer, must pay all of the insurance premiums, the cost is still far lower than most individual or conversion policies for similar coverage.
Oefore the new state continuation law went into effect, the covered person could lose membership in a group plan at the end of the COORA continuation period. Now, with the passage of the new continuation law, many individuals age 60 and older may continue to participate in the same group plan until they are eligible for Medicare at age 65, even if their COORA continuation period has ended.
Group health insurance premiums are generally much lower than premiums for individual or conversion health insurance policies. Individual and conversion policies are especially expensive when purchased by

older persons because of the higher risl~ that an older person will incur expensive claims. In fact, for many older Georgians, health insurance is unavailable at any price.
Comparing COBRA and the New State Law
The new continuation law does not limit an individual's rights under COORA; it merely extends coverage beyond the COORA period. Under both COORA and the new continuation law, only employers with 20 or more employees must provide employees the opportunity to continue coverage.
There ore, however, some differences between COORA and the new continuation law:
1. Who Is covered:
COORA: Employees, their spouses and dependents ore eligible if they were covered by the group plan on the day before a "qualifying event" (an event wrich allows a qualified beneficiary to elect continuation coverage).
State Law: Employees and their spouses age 60 or older, and their dependent children. ore eligible if they were covered by the group plan on the day before a qualifying event.
2. When must on employer (with 20 or more employees) offer the option to eled group plan continuation?

COORA: Qualifying events are: a. death of the employee b. termination or reduction in hours of employment (whether involuntary ar not) UNLESS due to the employee's "gross misconduct" c. divorce ar legal separation d. employee's entitlement to Medicare e. dependent no longer covered under parent's policy f. employer declares banl~ruptcy (far certain qualified beneficiaries)
State law: Electing coverage under COORA constitutes election under state law, except that the state law does not provide continuation if: a. termination of employment is voluntary for other than health reasons b. employment was terminated far any reason that would mal~e an employee ineligible for unemployment compensation c. covered person failed to pay premiums d. person is covered by similar group coverage e. the group plan was terminated for everyone in the group
3. How much does group coverage cost?
COm~A: The maximum that can be charged is 102 % of the amount charged other group members for the same plan. The employer is not reqUired to pay any port of the premium.
State law: The maximum that can be charged is 120% of the amount charged other group members for the same plan. The employer is not reqUired to pay any part of the premium.

Note that both COOP.A and the new state low apply their continuation rights to those who worl~ for businesses with more than 20 employees. Worl~ers with smaller businesses, who have been insured for at least six months, and who have their insurance coverage terminated for any reason, may continue coverage (including eligible dependent coverage) for three months following the month in which coverage terminated.
The maximum that can be charged for this coverage is 100% of the amount charged other group members for the some plan. The employer is not required to pay any part of the premium.
History of the New Law
The new continuation low was sponsored by P.ep. Wesley Dunn of McDonough. The Older Women's League (OWL), Metro Atlanta chapter, initiated the efforts to pass this low in response to the critical problem of unaffordable health insurance for many older Georgians. OWL was assisted in the legislative advocacy by the Senior Citizens Advocacy Program.
The low went into effect July 1, 1992. For more information about this and other insurance matters, call the Office of the Insurance Commissioner, Consumer Services, 404-656-2070 or write them at Seventh Floor, West Tower, 2 Martin Luther King Jr. Drive, Atlanta, GA 30334.