State Legislation

Mini-COBRA – Act 2 of 2009

Employers with fewer than 20 full-time employees who are not already obligated to offer federal COBRA must offer extended health benefits to employees and eligible dependents with qualifying events as of July 10th, 2009, as long as the following applies to the beneficiary:

• They had group coverage for the three months prior to termination
• They are not eligible for Medicare
• They are not eligible for or covered by other private group health insurance

When health coverage ends due to a qualifying event, the employer must provide notice to the employee and/or eligible dependent. An employer must give notice of a qualifying event to the covered employee and the insurance company within 30 days of the qualifying event. The employee or employee’s dependent must give notice to the administrator (who may be the employer) of his or her election within 30 days of receiving notice of the qualifying event.

Once the administrator receives notice from the employee and/or dependents that they are electing Mini-COBRA, the administrator must in turn give notice to the insurance company of the employee’s or dependent’s election within 14 days of the election. The continuation coverage will begin as of the date the prior group coverage ended, so that there is no break in coverage.

Mini-COBRA continuation health coverage can extend for nine months, regardless of the nature of the qualifying event. If a recipient becomes eligible for Medicare or other employer-based coverage, or fails to pay premiums on a timely basis, then Mini-COBRA coverage will end.

A 65% premium reduction will also apply for employees and eligible dependents that were involuntarily terminated on or after July 10th, 2009 through May 31st, 2010:

• The premium assistance eligible individuals will only be required to pay 35% of the premium amount for Mini-COBRA continuation coverage.
• The remaining 65% will be paid by insurance company, not the employer.

In addition, individuals with an involuntary termination of employment between March 2nd, 2010 and May 31st, 2010 following a reduction of hours from September 1st, 2008 through May 31st, 2010 may also qualify for the premium reduction.

For more information, visit the PA Insurance Department's website

Insurance Coverage for Autism Spectrum Disorder – Act 62 of 2008

Beginning July 1st, 2009, private health insurance companies are required to cover the cost of diagnostic assessment and treatment of autism spectrum disorder and services for children under the age of 21, up to $36,000 per year. Also, the Pennsylvania Department of Public Welfare will be required to cover the cost of services for individuals who are enrolled in the Medical Assistance program and do not have private insurance coverage, or for individuals whose costs exceed $36,000 in one year. In addition, the Pennsylvania Department of State will be required to license professional behavior specialists who provide services to children.

Children or young adults under the age 21 diagnosed with autism spectrum disorder will be covered if they are on an employer group health insurance policy that has more than 50 employees and is not self-insured, if they are on Medical Assistance, or if they are covered by Pennsylvania’s CHIP or adultBasic program.

Additional information can be found on the PA Department of Public Welfare website or at www.PAAutismInsurance.org.

Click here for the House Bill.

Extension of Dependent Eligibility – Act 4 of 2009

At the discretion of an employer, all health care insurers must now provide health coverage to a child of an insured employee up through and including the age of 29, provided that the child meet all of the following requirements:

• They are not married.
• They have no dependents.
• They are a resident of the Commonwealth of Pennsylvania or are enrolled as a full-time student at an institution of higher education.
• They are not provided coverage as a named subscriber, insured, enrollee or covered person under any other group or individual health insurance policy or enrolled in or entitled to benefits under any government health care benefits program, including benefits under Title XVIII of the Social Security Act.

This act will only apply to new contracts and contract renewals occurring 180 days (six months) after June 10, 2009.

Click here for the Senate Bill.

The Children's Health Insurance Program Reauthorization Act (CHIPRA)

See Federal Legislation for additional information.