legal and insurance issues to consider• host: eva lamanna program coordinator, cancer and careers...
TRANSCRIPT
LEGAL AND INSURANCE ISSUES TO CONSIDER
• Host: Eva LaMannaProgram Coordinator, Cancer and Careers
• Joanna Fawzy Morales, Esq. Cancer Rights Attorney &Principal, North Star [email protected] @CancerRights
SPEAKERS
This publication is designed to provide general information on the topics presented. It is provided with the understanding thatthe author and speakers are not engaged in rendering any legal or professional services by its publication or distribution.
Although these materials were reviewed by professionals, they should not be used as a substitute for professional services.
© 2012 North Star Alliances
• After college, Erin worked as an assistant at a large company for 3 years. At the age of 24, she was diagnosed with cancer.
• After talking with her healthcare team, she decided her best course of action was to take some time off work.
• Erin has heard about COBRA to keep her health insurance coverage, but she is concerned about how to get insurance coverage with a pre-existing condition, once her 18 months of COBRA is over.
• Erin is now 26 and is ready to get back into the workforce. • She isn’t sure how to deal with the gap on her resume, and how to address it
in an interview. Or if she even has to.• Erin also has monthly medical appointments and has been experiencing chemo
brain. She is worried this will keep her from getting a job.• Erin wants to know about her options.
ERIN’S STORY
EMPLOYMENT RIGHTS
o Federal Americans with Disabilities Act (ADA)o Discrimination protections for patients and caregiverso Reasonable Accommodations for patients
o State Fair Employment Lawso Discrimination protections for patients and caregiverso Reasonable Accommodations for patients
o Employer Policieso Employee Manualo Employment Contracto Independent Contractor’s Contracto Union Contract
EMPLOYMENT LAWS
o Eligibilityo Private employers with 15 or more employeeso Be a “qualified individual”o Have a disability under the ADA’s definition:
o “A physical or mental impairment that substantially limits one or more major life activities”
o Major life activities: eating, breathing, walking, talkingo ADA Amendments: concentrating, thinking, sleeping,
operation of major bodily functions
AMERICANS WITH DISABILITIES ACT
o 3 ways to use the ADA:1) Currently 2) History 3) Regarded
o Benefits of the ADA:1) Protection from Discrimination2) Reasonable Accommodations
AMERICANS WITH DISABILITIES ACT
DISCLOSURE RIGHTS
o Generally, not requiredo Need to disclose to use ADA’s protectionso Need to disclose to use reasonable accommodationso Need to disclose to use medical leave
o Medical Certificationo Employers entitled to medical certification for RA’s & FMLAo But diagnosis may not be required!!!o ADA v. FMLA (be careful of forms and state laws)
REASONABLE ACCOMMODATIONS
o What are Reasonable Accommodations?o When do you ask?o How do you ask?o Who do you ask?o Is your request confidential?o What is the interactive process?
o Job Accommodation Network: www.AskJan.org
o Adjusting your work spaceo Changing your work schedule
o Telecommutingo Rest breakso Flexible scheduleo An extended period of leave
o Use of technology
REASONABLE ACCOMMODATIONS
JOB APPLICANTS
o Disclosureo If, when, and howo Required for use of ADA protections
o Reasonable Accommodation Requestso If, when, and how
o Medical Examso If, when, and how
o Similar to ADAo Can be more protective
o Broader definition of disabilityo Ex: CA, IL, IA, NY, WA, WI
o Specifically list cancer as a disabilityo Ex: CA, ME, OH, VT
o Cover employers with fewer than 15 employeeso Ex: MA (6), NY (4), CT (3), IL (1)
STATE FAIR EMPLOYMENT LAWS
o Federal Family & Medical Leave Act (FMLA)o Up to 12 weeks of unpaid, job-protected, health insurance
protected leave, per yearo For patients and caregiverso Eligibility: 50+ employees (75 miles), 1250 hours, 12 monthso Can work with the ADAo Employers can require use of PTO
o State Paid Leave for Caregiverso Ex: California & New Jersey
TAKING TIME OFF WORK
o Disability Insuranceo Private Disability Insurance
o Purchase through employero Purchase directly from company
o State Disability Insuranceo CA, NY, NJ, RI, HI, and PR
o Federal Disability Insuranceo Social Security Disability Insurance (SSDI)o Supplemental Security Income (SSI)
INCOME OPTIONS
o HIPP programo IHSS (for caregivers)o Private programs
o Patient Services, Inc.o Cancer organizations
o Cancer Careo American Cancer Societyo Leukemia and Lymphoma Societyo The Pink Fund
FINANCIAL ASSISTANCE OPTIONS
HEALTH INSURANCE OPTIONS
www.HealthCare.gov
o COBRAo Job-locko Employer-sponsored health insuranceo Employers with 20+ employeeso Length depends on qualifying evento Cost up to 102% of applicable employee rate
o State COBRAo Conversion
EMPLOYER-SPONSORED HEALTH INSURANCE
Qualifying Event Qualified Beneficiaries Maximum Coverage
Termination of employment or reduction in hours
Employee, Spouse, DependantChild
18 months
Employee enrollment in Medicare
Spouse, Dependant Child 36 months
Divorce or legal separation Spouse, Dependant Child 36 months
Death of employee Spouse, Dependant Child 36 months
Loss of dependant child status
Dependant Child 36 months
WHEN TO USE COBRA
o Reduces job-locko Prohibits discrimination based on pre-existing medical
conditions o Applies when moving from:
o Group to group o COBRA to a HIPAA plan
o 63 DAYS
HEALTH INSURANCE PORTABILITY & ACCOUNTABILITY ACT (HIPAA)
1. HIPAA Plano Federally Insured Plan or Guarantee Issue Plano Every insurance company that writes individual
policies in that state, must offer a HIPAA plano OR some states may have conversion plans or provide a
HIPAA option through the state’s high risk pool
o Eligibility:o Exhaust COBRA or State COBRA plan o Be ineligible for a group plan, Medicare, or Medicaid
o No gap more than 63 days
WHEN COBRA ENDS
2. Pre-existing condition exclusion period (PECEP)o Denial of coverage for a period of timeo Group plans can’t deny employees insurance, but they can
impose a PECEPo PECEP = 12 months maximum
o Some states less, for example: CAo 1-2 employees = up to 12 monthso 3+ employees = up to 6 months
o Look back = 6 months o PECEP runs concurrently w/ waiting period for benefits
WHEN CHANGING INSURANCE PLANS
3. Creditable Coverage:o Almost any type of comprehensive health insurance
o Except some student health insurance plans
o Goes with you from one health insurance plan to anothero Reduces or eliminates a PECEP imposed by a new plano Cannot have gap in coverage over 63 days
REDUCING OR ELIMINATING PRE-EXISTING CONDITION EXCLUSIONS
Example #1: Your patient had health insurance through his employer for 2 months while at a previous job. Your patient is changing jobs and the new employer group health plan is imposing a pre-existing condition exclusion period (PECEP) of 6 months.
6 month PECEP imposed by new group health plan –2 months of prior creditable coverage =
only 4 months left of a PCEP
Therefore, your patient will only have a 4 month exclusion period.
HOW TO USE CREDITABLE COVERAGE
Example #2: Your patient had health insurance through his employer for 8 months while at a previous job. Your patient is changing jobs and the new employer group health plan is imposing a pre-existing condition exclusion period (PECEP) of 12 months.
12 month PECEP imposed by new group health plan –8 months of prior creditable coverage =
only 4 months left of a PCEP
Therefore, your patient will only have a 4 month exclusion period.
HOW TO USE CREDITABLE COVERAGE
o AKA: Major risk insurance planso For people who are unable to get individual health insuranceo Not available in every stateo Plans are different in each state:
o TX: Health Insurance Risk Pool o CA: Major Risk Medical Insurance Program
o Can be annual caps, lifetime maximums, & waiting listso To find plans in your state:
o www.HealthCare.gov
HIGH RISK INSURANCE POOLS
o Patient Protection & Affordable Care Act (PPACA)o Health care reform
o Eligible:o U.S. Citizens or lawful residento Have a pre-existing illness or conditiono No creditable coverage for 6 months
o Premiums, deductibles, co-pays, etc. varyo Annual out of pocket costs capped at $6,050 (in network)o www.pcip.gov
PRE-EXISTING CONDITION INSURANCE PLANS (PCIP)
PCIP IN EACH STATE
PATIENT PROTECTION & AFFORDABLE CARE ACT (PPACA)
o Young Adultso Children under 19o Rescissionso Lifetime and annual limitso Free preventative serviceso Medical Loss Ratio: 80%-85% (large groups)o 2014: Adults!
• After college, Erin worked as an assistant at a large company for 4 years. At the age of 25, she was diagnosed with cancer. After talking with her healthcare team, she decided her best course of action was to take some time off work.
• Erin heard about COBRA to keep her health insurance coverage, but she is concerned about how to get insurance coverage with a pre-existing condition, once her 18 months of COBRA is over. HIPAA, HIPP, High Risk, PCIP
• Erin is now 27 and is ready to get back into the workforce. • She isn’t sure how to deal with the gap on her resume, and how to address it
in an interview. Or if she even has to. ADA, State Law, Disclosure• Erin also has monthly medical appointments and has been experiencing chemo
brain. She is worried this will keep her from getting a job. ADA, State Law, Reasonable Accommodations
ERIN’S STORY REVISITED
RESOURCESo Legal Assistance:
o National Cancer Legal Services Network www.NCSLN.orgo LawHelp www.lawhelp.org
o Employment:o Equal Employment Opportunity Commission www.EEOC.govo Job Accommodation Network www.AskJan.orgo U.S. Department of Labor www.dol.gov/ebsao Workplace Fairness www.workplacefairness.org
o Disability Insurance Options:o Social Security Administration: www.SSA.gov
o Health Insurance Options:o www.HealthCare.govo www.PCIP.gov