Know Your Health Insurance Rights

Whether it is through an employer or a private health insurance plan, roughly 84% of Americans have health insurance coverage. However, many people never reap all the benefits of their coverage, because they simply do not know their health insurance rights. There are many laws that regulate health insurance coverage, and knowing these laws is important to understanding your health insurance rights.

Listed below are key health insurance rights that you should be aware of:

Continuation of benefits when your coverage is interrupted

Through the Consolidated Omnibus Budget Reconciliation Act (COBRA), the federal government ensures that workers and their families who lose their health insurance benefits have the right to choose to continue the benefits provided by their group health insurance plan. Under COBRA, employers who employ at least 20 employees the previous year must offer their employees and their employees' families the opportunity for continuation of group health coverage, when such coverage would ordinarily end. The act is designed to cover you for a limited amount of time, typically 18 to 36 months, and includes certain circumstances like voluntary or involuntary job loss, a decrease in hours at work, job transitions, death of the worker, divorce, and certain other life events. The length of time your coverage continues depends on your circumstances:

• If you have voluntarily or involuntarily lost your job or your hours are reduced, you can continue coverage for yourself, your spouse, and your dependents for 18 months.
• If you are covered through a parent's plan and your coverage will end due to you reaching a certain age or because you are no longer a dependent of your parents, you can continue coverage for yourself for 36 months.
• If your coverage is ending because you are divorcing or separating from the policy-holder or the policy-holder has died, you can continue coverage for 36 months.

If you qualify, you might have to pay the entire premium up to 102% of the plan's cost. However, you are entitled to only pay the group rate, which is usually far less expensive than an individual policy rate.

COBRA also mandates certain requirements of your employer, the health insurance plan, and you (whether you are the employee or a covered family member):

• The health insurance plan must give you notice about your general COBRA rights.
• Your employer must give the health insurance plan notice of a covered employee's death, decrease in an employee's hours, or the termination of an employee's employment (whether voluntary or involuntary).
• You (employee or employee's family member) must give the health insurance plan notice of divorce, legal separation, disability, or the change of a child's dependency status.
• You must also give the health insurance plan notice within 60 days, beginning on the date your coverage would ordinarily end, if you want to continue coverage.

Newborn and maternity coverage

The Newborns' and Mothers' Health Protection Act of 1996 (NMHPA) affects the amount of time you and your newborn are covered for the hospital stay after your child's birth. Under NMHPA, you and your newborn are covered to stay in the hospital for at least 48 hours after your child's birth or 96 hours after a cesarean delivery. Of course, you may leave the hospital at any time, if you and your health care provider agree it is okay, but NMHPA prohibits insurers from encouraging you to leave earlier.

Mental health and substance abuse coverage

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) prohibits health insurance plans from providing less coverage for mental health conditions, including substance abuse, than they provide for physical conditions. MHPAEA prevents your group health insurance plan from imposing financial requirements, treatment limitations, and annual or lifetime dollar limits on mental health and substance abuse benefits that are less favorable than those imposed on medical and surgical benefits offered under the same plan. This protection is only imposed on group health plans that already provide mental health and substance abuse benefits and the act provides three exceptions:

• The MHPAEA requirements only apply to employers with more than 50 workers.
• Large group health insurance plan sponsors who meet certain requirements may request exemption from the MHPAEA, and may then notify their covered members that the MHPAEA does not apply.
• A nonfederal governmental employer who provides self-funded group health plans may opt out of the requirements of the MHPAEA by following certain procedures and issuing notice to its members.

An early version of the MHPAEA was first established in 1998, and since then, it has undergone several changes, including applying to substance abuse benefits, to address the changing health care needs. The latest revisions are effective April 5, 2010, and include the following additional provisions: