There are federal laws which give people the chance tocontinue employer-sponsored medical insurance coverage (including for their children) when a person experiences a qualifying event (defined in the COBRA section). Even though you may have the right to keep your insurance coverage for some months, there are no laws that guarantee the insurance will be adequate or that you will be able to affordable it.

COBRA (Consolidated Omnibus Budget and Reconciliation Act of 1986)

COBRA gives you, your spouse, or your dependents the right to temporarily continue health insurance coverage. Though you still get group rates, you usually pay much more than when you were working, since you must now pay the portion that your employer paid plus a small administrative fee. This insurance is available when other coverage is lost because of certain specific events (called qualifying events), such as stopping work, reducing work hours, divorce or legal separation, the covered person becoming entitled to Medicare, a dependent child is no longer considered to be dependent according to the terms of the plan, or the death of the employee.

COBRA allows people to continue being covered by their group medical insurance for a period of up to 18 months, or 29 months if a beneficiary is considered disabled. (This determination of disability is made by the Social Security Administration.) If a person is fired for gross misconduct they will not be eligible for COBRA.

COBRA is not given automatically but must be elected by the former employee or beneficiary within 60 days of stopping employment. The employer must also notify an employee that COBRA is available after work is stopped or hours are reduced, usually about 2 weeks after the qualifying event occurs.

The employee or the employee's dependent (spouse or adult child) must notify the plan administrator of family changes, such as these situations:

• divorce
• legal separation
• an employee's child reaches the status of non-dependent
• the employee becomes eligible for Medicare

If this notice is not done within the deadline, the spouse or child may lose their COBRA rights. If coverage for your dependent(s) is ending for any of those reasons or because of the employee's death, their coverage may be continued for up to 36 months.

Contact the employer's human resources person, the insurance company, or check the policy to find out the details of what must be done and who should do it.

You can keep your health insurance if the premium is paid, until you, your child, or your spouse becomes covered under another group policy, for up to 18 months (29 months if disabled.) For a spouse or dependent beneficiary (such as your child), coverage can last up to 36 months for certain qualifying events. Premiums cannot be above 102% of the cost of the plan for employees in similar situations who do not have a "qualifying event."

Families are often concerned about their ability to continue payment of the insurance premiums. If this is the case, you can discuss the matter with the team social worker who may have ideas about how to get help with these costs. (See What is COBRA? for more detailed information about COBRA, including getting short-term help paying COBRA premiums based on the American Recovery and Reinvestment Act of 2009. Visit our Web site or call us for a copy.)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA)

This Act makes it easier for a parent to change jobs and move from one group insurance plan to another. It has several clauses that can help parents of children or teens with cancer:

• It allows a parent who has had group medical insurance for at least 12 months with no loss of coverage longer than 63 days, to change jobs and be guaranteed other coverage with a new employer who also offers group insurance. In this situation there may be no waiting period and a dependent cannot be denied coverage because of a pre-existing health problem. (See "Pre-existing condition exclusions" in the section, "Private Health Plans.")

• If a parent is uninsured beforehand, and takes a job with an employer who offers group insurance, the pre-existing condition exclusion period for the employee and their dependents cannot be longer than 12 months.

• HIPAA requires insurers to renew coverage for all employers and individuals when premiums are paid.

• HIPAA also guarantees that group insurance coverage is available for employers with 2 to 50 employees. But it does not require these small employers to buy the insurance that is offered.

• HIPAA helps protect anyone left out of group health coverage after COBRA has run out. If you are eligible and act within 63 days of losing COBRA coverage, HIPAA guarantees that you can buy some type of coverage and that you will have a choice of at least 2 options. But it is important to know that no one will notify you that you are eligible or of the 63 day time limit. Contact your state insurance department or commission to find out what is available to you, or call us.

For more information about HIPAA visit our Web site or call and ask for What is HIPAA? or contact your state department or commission of insurance. Go the "Additional resources" section for contact information.

The Family and Medical Leave Act of 1993 (FMLA) can also affect health coverage

This Act requires employers with at least 50 employees to provide up to 12 weeks of unpaid, job-protected leave for eligible employees for certain family and medical reasons. Having a child with cancer is certainly a reason to take family leave.

Employees are eligible if they have worked for a covered employer for at least 1,250 hours in the previous 12 months. For the time period of the FMLA leave, the employer must maintain the employee's health coverage (including dependents).

Your child's pediatric oncologist and the team social worker can help provide the necessary paperwork for your employer. This act is regulated by the U.S. Department of Labor's Wage and Hour Division. They can give you more information. Check the telephone directory in your area under U.S. Government, Department of Labor for contact information or find it in the "Additional resources" section.

The Americans with Disabilities Act of 1990 (ADA)

This Act offers protection against discrimination in the workplace to anyone who has, or has had, certain disabilities, including any diagnosis of cancer. Parents of dependent children with cancer are also protected under this law. The ADA requires private employers who employ 15 or more people, labor unions, employment agencies, and government agencies to treat employees equally, including the benefits offered them, without regard to their disabling condition or medical history. It also does not allow employers to screen out potential employees who have children with disabilities.

This Act, along with the Health Insurance Portability and Accountability Act, makes it easier for a parent to change jobs and move from one group insurance plan to another. This law is administered by the U.S. Equal Employment Opportunity Commission (EEOC). They can answer questions and give you more information on a special telephone line (see the "Additional resources" section. You can also get more information from Americans with Disabilities Act: Information for People Facing Cancer. You can read it on our web site or call us for a copy.)

Back to Children Diagnosed with Cancer: Financial and Insurance Issues

Last Medical Review: 04/01/2009
Last Revised: 04/01/2009