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Compliance Assistance Resources

elaws - employment laws assistance for workers and small businesses

- Health Benefits Advisor

My New Employer's Group Health Plan

There are many reasons why employees change jobs and many things to consider when doing so. The type of group health plan offered by the potential employer compared to your current plan may be one consideration, especially if you or a family member has special needs. Therefore, you will want to compare the group health plan offered by your potential employer to the coverage you currently have.

In order to compare coverages, you should ask for a copy of the new plan's SPD (summary plan description) and compare it to the SPD for your current plan if your current coverage is group health coverage. If it is not, then compare the SPD for the new plan to the benefit book provided by the insurance carrier or HMO. Among the factors you should consider are the eligibility rules of the plan, premiums you'll pay under the new plan, the amount of co-payments and deductibles for prescription drugs and doctor visits, the benefits offered under the options, and whether you can continue with the same doctors. You will also want to know whether the new plan imposes any waiting period (or affiliation period) before you or your family are eligible to receive benefits or has any pre-existing condition exclusion periods or other limitations on benefits.

Whatever coverage you choose, you should try to avoid incurring a significant break in health coverage, especially if you or a family member has a medical condition that requires regular medical attention. A significant break in coverage is a period of 63 consecutive days (longer in some states) during which you have no health coverage. To shorten the length of a new group health plan's pre-existing exclusion period, a plan is not required to count any coverage you may have had prior to any significant break in health coverage. If you have a significant break in coverage, you may have to pay more out-of-pocket costs to meet your health needs.

While waiting periods do not generally count towards a significant break in health coverage, time spent on a waiting period also will not shorten any pre-existing condition exclusion period established by a group health plan. Therefore, if the new employer's plan has a waiting period, you should seriously consider maintaining some sort of health coverage during that period.

If you had group health coverage from your former employer, you and your family members may be entitled to elect COBRA continuation coverage, which is a temporary continuation of the group health coverage you had before you left your former employer. Generally, group health plans maintained by employers with 20 or more employees must offer COBRA continuation coverage to any covered employees (and their family members) who terminate employment for any reason other than gross misconduct. You could elect to have  COBRA continuation coverage during any waiting period imposed under your new employer's group health plan.

Your former employer's group health plan is required to give you a written election notice explaining your right to elect COBRA continuation coverage. If you are eligible, you will have at least 60 days from the date the notice is sent or from the date your coverage ends, whichever is later, to elect COBRA. You may be required to pay for COBRA continuation coverage. If the employer is too small to be subject to COBRA, state law may require the plan's insurer to provide some continuation coverage.

The decision whether or not to elect COBRA continuation coverage may affect the rights of you and your family to future health care benefits or to coverage that you may obtain outside of employment. For example, if you do not elect and exhaust COBRA, you will not be eligible for guaranteed access to an individual insurance policy under Health Insurance Portability and Accountability Act (HIPAA). Therefore, additional information should be considered. For more information, see Deciding Whether to Elect COBRA Health Care Continuation Coverage After Enactment of HIPAA

For more information on COBRA continuation coverage and your other options, return to the Changing Jobs Page.