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What You Need to Know -
Get all the details on your spouse's plan, and
be sure you understand how it works. You'll want to know the
amounts of any deductibles or copays you will be required to
pay, and what you will pay for premiums.
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Under the Health Insurance Portability and Accountability Act (HIPAA), you may be entitled to add yourself, a new spouse and
children to your employer's plan or to your spouse's employer's
plan under a special enrollment period.
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What You Need
to Do -
To qualify for the special
enrollment period, you must notify the plan and request special
enrollment for everyone enrolling within 30 days of your marriage.
Your plan may require that the notice be in writing and that
is usually the safest course of action anyway.
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If your spouse has health coverage available, compare the health
benefits, cost and options under both plans, and decide which
one works best for you.
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What You Need to Know -
HIPAA places limits on
the amount of time a pre-existing condition exclusion period
may apply. In addition, health care plans cannot consider pregnancy
a pre-existing condition, even if the woman did not have previous
coverage.
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Birth and adoption (including placement for adoption) may trigger
a special enrollment period during which you, your spouse and
new dependents can enroll in your employer's plan. Additionally,
newborns and adopted children are not subject to pre-existing
condition exclusions if they enroll within 30 days of the birth
or adoption.
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Under the Newborns' and Mothers' Health Protection Act, plans
that provide maternity or newborn benefits generally must provide
coverage for mothers and newborns to stay in the hospital at
least 48 hours following a vaginal delivery or 96 hours following
a cesarean section, unless the doctor or other attending provider
in consultation with the mother discharges earlier.
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What You Need
to Do -
You must notify your plan and request special enrollment
within 30 days of your child's birth, adoption, or placement
for adoption. The child's enrollment will be treated as occurring
on the date of the birth, adoption, or placement for
adoption. Your plan may require that the notice be in writing.
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Find out if your plan covers well-baby care. If not, you may
need to figure extra money into your budget to cover vaccinations
and appointments the baby will need during the first few months
of life.
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What You Need to Know -
Most health care plans will provide coverage to
dependent children until they reach the age of 19 or the age of 25
if they are full-time students. Once your child loses dependent
child status under your health care plan's rules, the child
may be eligible to purchase temporary extended health care coverage
for up to 36 months under the Consolidated Omnibus Budget Reconciliation
Act (COBRA). Generally, COBRA covers group health plans maintained
by employers with 20 or more employees.
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What You Need
to Do -
Once your covered child
is no longer a dependent, notify your employer in writing within
60 days. In turn, your plan should notify your child of his or
her right to extend health care benefits under COBRA. Your child
will have 60 days from the date the notice was sent to elect
COBRA coverage. The cost will be higher, since the employer will
no longer pay a portion, but it is usually less than the cost
of individual coverage.
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What You Need to Know -
When an employee covered
under an employer-sponsored health plan dies, legally separates
or divorces, the covered spouse and dependent children may be
eligible to purchase temporary extended health coverage for up
to 36 months. The cost will be higher, since the employer will
no longer pay a portion, but it is usually less than the cost
of coverage they might obtain on their own.
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If the spouse losing coverage under the plan has a health plan
available through his or her employer, the spouse and any dependents
may be eligible to obtain coverage through special enrollment.
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If the covered employee dies or in the event of a legal separation
or divorce, the plan should notify the covered spouse and dependent
children of their right to purchase extended health care coverage
under COBRA. Most plans require eligible individuals to make
their COBRA election of coverage within 60 days of the plan's
notice.
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What You Need
to Do -
Should the employee who is covered by the health
care plan die, the employer must notify the plan within 30 days.
If there is a divorce or legal separation, the covered employee,
spouse or dependent children must notify the plan in writing
within 60 days. In case of death of the covered employee, divorce
or legal separation, the plan should notify the eligible spouse
and dependent children who would lose coverage under the plan
of their right to purchase temporary extended health care coverage.
Most plans require eligible individuals to make their COBRA election
within 60 days of the plan's notice.
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If the spouse losing coverage under the plan has a health plan available
through his or her employer, the spouse and dependent children may be
eligible for a special enrollment under that plan. To qualify, the spouse
must notify that plan and request special enrollment within 30 days of the
loss of coverage.
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