For U.S. Residents Only

Health Insurance Laws

If you are losing health insurance coverage because you or your spouse has lost a job, or because of divorce and your insurance was provided through your spouse, there are two federal laws that you should know about—COBRA and HIPAA.

COBRA (the Consolidated Omnibus Budget Reconciliation Act) can provide you and your family with a temporary extension of health coverage. The law applies to you if your employer has at least 20 employees and if you meet certain conditions:
  • If you're losing coverage because you quit your job, your hours were reduced, or you were terminated (for reasons other than "gross misconduct"), you can continue coverage for yourself, your spouse, and your dependent children for 18 months. Be aware that the 18-month period can be increased to 29 months if someone in the family is disabled.

  • If you're losing coverage because of divorce or the death of your spouse, coverage for you and your dependent children can be continued for 36 months.

If you are eligible for COBRA, your health plan is responsible for notifying you of your right to continue coverage under the plan. You will have at least 60 days to choose COBRA. If you do not elect COBRA coverage within the time period, you will lose all rights to benefits.

COBRA coverage, though federally mandated, is not a government benefit. You will have to pay the entire cost of group coverage plus a 2% additional administration charge. So you'll be paying more than when you or your spouse was employed, but considerably less than individual rates.

HIPAA (the Health Insurance Portability and Accountability Act) will protect you if you have what is known as a "preexisting condition"—an illness or condition for which medical advice, diagnosis, care, or treatment was received in the 6 months before enrollment in the current plan.

Does this affect you? Before HIPAA was enacted in 1996, if you received treatment for lung cancer in June and enrolled in a new group insurance plan the following January, your new plan could have excluded coverage of any lung cancer treatment for several years or longer because you had previously been treated for it.

Under HIPAA, there is a 6-month "look-back" limit on identifying preexisting conditions. That is the most important feature for those with lung cancer recurrence: if you were last treated for lung cancer more than 6 months before enrolling in your current plan, then lung cancer is not considered a preexisting condition and its treatment must be covered as soon as the plan takes effect.

If you have received treatment for your cancer within 6 months of enrolling in your new plan, the plan can exclude coverage for 12 months—or 18 months if you did not enroll in the plan when you were first eligible.

Also, if you switch from one group health plan to another as the result of a job change, you will not face new preexisting condition exclusions, as long as there is no more than a 63-day break in coverage.

Consider HIPAA Before Electing COBRA

Because you bear the cost of COBRA coverage, you may not want to pay for it when you are quitting a job to take another one that offers health insurance, as long as you have not received treatment for lung cancer for at least 6 months.

On the other hand, if you have lost your job and do not have another lined up in the foreseeable future, or if you have recently received treatment for lung cancer, locking in health insurance under COBRA may be a good course of action to take.

If you do not have adequate health insurance, or any at all, you may have reimbursement options available. Please visit http://www.medicare.gov/prescription/Home.asp for details.

Sources of Information

These organizations and Web sites provide information regarding health insurance issues:
  • Cancer Care, Inc.
    275 7th Avenue
    New York, NY 10001
    1-800-813-HOPE (1-800-813-4673)
    http://www.cancercare.org
    Provides free help to cancer patients by offering information on cancer treatments, financial assistance, and other support services.

  • Health Insurance Association of American (HIAA)
    1201 F Street, NW, Suite 500
    Washington, DC 20004-1204
    1-202-824-1600
    http://www.hiaa.org/consumer
    Provides insurance guides for consumers on topics such as health insurance, managed care, disability income, long-term care, and medical savings accounts.

  • Social Security Administration (SSA)
    Office of Public Inquiries
    Windsor Park Building
    6401 Security Blvd
    Baltimore, MD 21235
    1-800-772-1213
    http://www.ssa.gov
    Provides comprehensive information about two programs, Social Security Disability Insurance and Supplemental Security Income.

  • Pharmaceutical Research and Manufacturers of America (PhRMA)
    1100 15th Street, NW
    Washington, DC 20005
    1-202-835-3400
    http://www.phrma.org
    A Web site offering information about pharmaceutical manufacturers' drug assistance programs for those in financial need.

  • Patient Advocate Foundation (PAF)
    700 Thimble Shoals Blvd, Suite 200
    Newport News, VA 23606
    1-800-532-5274
    http://www.patientadvocate.org
    Provides education and legal counseling for cancer patients concerning insurance and financial issues.

  • National Coalition for Cancer Survivorship (NCCS)
    1010 Wayne Avenue, Suite 770
    Silver Spring, MD 20910
    1-301-650-9127
    http://www.canceradvocacy.org
    One of the nationis largest networks of organizations and individuals serving people with all types of cancer.

  • National Partnership for Women & Families
    1875 Connecticut Avenue, NW, Suite 650
    Washington, DC 20009
    1-202-986-2600
    http://www.nationalpartnership.org
    A nonprofit organization that promotes fairness in the workplace, quality healthcare, and policies that help people meet the dual demands of work and family.

  • American Bar Association (ABA)
    750 N. Lake Shore Drive
    Chicago, IL 60611
    1-312-988-5000
    http://www.abanet.org
    Offers consumers information on various legal topics.

Additional Resources

You may find the information in the following publications helpful:

The Activist Cancer Patient: How to Take Charge of Your Treatment
Beverly Zakarian
John Wiley & Sons
ISBN: 047-112026X, 240 pages
May 1996


What Cancer Survivors Need to Know About Health Insurance and Working It Out—Your Employment Rights As a Cancer Survivor
National Coalition for Cancer Survivorship (NCCS)
1-877-NCCS-YES (622-7937) [General information and publication orders]
1-301-650-9127
http://www.canceradvocacy.org


What the Health Insurance Reform Law Means for Women & Families and Guide to the Family & Medical Leave Act
National Partnership for Women & Families
1-202-986-2600
http://www.nationalpartnership.org
Both available free of charge.

Cancer — Your Job, Insurance and the Law
American Cancer Society
1-800-ACS-2345
Available free of charge.