- Children Diagnosed With Cancer: Financial and Insurance Issues
- Covering the costs of cancer treatment
- Private health insurance options
- Types of private health plans for children
- How to manage your child’s health insurance
- Getting answers to insurance-related questions
- Keeping records of your child’s insurance and medical costs
- Handling a health insurance claim denial
- Keeping employer-sponsored health insurance coverage
- Government-funded health plans
- Who regulates insurance plans?
- Options for uninsured children
- What sources are available to help with treatment costs if my child doesn’t have insurance and there’s no public assistance available?
- Financial issues for families: Getting help with living expenses
- To learn more
Keeping employer-sponsored health insurance coverage
There are federal laws which give people the chance to continue employer-sponsored medical insurance coverage (including for their children) when a person has a qualifying event (defined below in the COBRA section). For many people COBRA can be a good option, but for others it may cost less to buy an individual plan to cover yourself and your family on the state health insurance marketplace. You may also qualify for financial help in buying a marketplace plan, especially if your family income has dropped with the job loss.
COBRA (Consolidated Omnibus Budget and Reconciliation Act of 1986)
COBRA gives you, your spouse, and/or your dependents the right to keep your health insurance coverage at the employer’s group rates. But because the employer usually covers a portion of the plan cost when you’re employed, you usually pay much more than you did while employed. You must now pay the portion that your employer paid plus a small administrative fee. In most cases, you can keep the insurance for up to 18 months. Some people may be able keep it for their child a few months longer.
For more details, read our document called What Is COBRA?
The new health care law now offers another option besides COBRA. You have the option to purchase new coverage through the state health insurance marketplaces. The marketplace plans may offer more affordable coverage options for you and your family than an employer plan through COBRA. Even if you lose your job at a time the marketplace doesn’t have open enrollment, you have 60 days in which you can buy a marketplace plan. See “Enrolling in a marketplace plan” in the “Private health insurance options” section for details.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
HIPAA is a federal law with many clauses that can help parents of children with cancer. This law applies only to grandfathered plans that existed when the Affordable Care Act went into effect in March 2010 and have not changed significantly since then.
Here are the ways HIPAA may help you:
- It allows a parent who has had a grandfathered health plan for at least 12 months with no long loss of coverage (usually more than 63 days) to change jobs and be guaranteed other coverage with a new employer (as long as that employer offers group insurance). In this case there may be no waiting period and the pre-existing condition exclusion may be reduced or not applied. (A pre-existing condition is a health problem that a person had before joining the health plan.)
- It requires insurers to renew coverage for all employers and individuals as long as premiums are paid on time.
- It guarantees that group insurance coverage is available to employers with 2 to 50 employees. (But it doesn’t require these small employers to buy and offer the insurance to their employees.)
For more information about HIPAA visit our website or call and ask for What Is HIPAA? You can also contact your state department or commission of insurance. Go the “To learn more” section for contact information.
The Family and Medical Leave Act of 1993
The Family and Medical Leave Act (FMLA) requires employers with at least 50 employees to provide up to 12 weeks of unpaid, job-protected leave for eligible employees with certain family and medical needs. 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 coverage for dependents.
Your child’s pediatric oncologist and the team social worker can help with the paperwork your employer needs for FMLA leave.
This act is regulated by the US Department of Labor’s Wage and Hour Division. They can give you more information. Check your local phone book under US Government, Department of Labor for contact information or find it in the “To learn more” section. Also, our document called Family and Medical Leave Act (FMLA) can give you more details on this option.
The Americans With Disabilities Act of 1990
The Americans With Disabilities Act (ADA) helps to protect anyone who has, or has had, certain disabilities, including cancer, against discrimination in the workplace. 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 doesn’t allow employers to screen out potential employees who have children with disabilities.
This Act, along with the Health Insurance Portability and Accountability Act (HIPAA), makes it easier for a parent to change jobs and move from one group insurance plan to another. This law is overseen by the US Equal Employment Opportunity Commission (EEOC). They can answer questions and give you more information by phone at 1-800-514-0301. You can also get more details in our document called Americans With Disabilities Act: Information for People Facing Cancer.
Last Medical Review: 11/13/2014
Last Revised: 01/08/2015