Group Health

Can my employer change our health insurance carrier and level of benefits during the year?
What happens when my group health coverage ends?

COBRA Benefits

What happens to my group health coverage if leave my employer?

Individual Health

Can my health insurance carrier continue to raise my premium rates?

Medigap (Medicare Supplements)

When should I apply for a Medigap policy?
I am not satisfied with the company I have my Medigap policy with. How often can I switch companies?

Group Health

Can my employer change our health insurance carrier and level of benefits during the year?

Yes. It is completely up to the employer whether or not they will offer health insurance to employees at all and they can change carriers and level of benefits at any time.

What happens when my group health coverage ends?

You can apply for individual health coverage under the federal law Health Insurance Portability and Accountability Act (HIPAA). This type of policy is issued on a guaranteed issue basis if you meet the qualifying criteria. However, there is no limit on the maximum premium the company can charge.

COBRA Benefits

What happens to my group health coverage if I leave my employer?

Under federal and state law, employers that have a group health plan are required to offer their employees (and their dependents) the option of continuing their membership in the group plan at their own expense after they leave their job. This is known as "electing COBRA," and these employees are entitled to continue coverage for 18 months.

Events that qualify for continuation of coverage:

• Voluntary or involuntary termination of employment for any reason except gross misconduct - employee entitled to continuation.
• Death of a covered employee - spouse and dependent children entitled to continuation.
• Divorce or legal separation of a covered employee - spouse and dependent children entitled to continuation.
• Covered employee becomes eligible for Medicare - spouse and dependent children entitled to continuation. Loss of child coverage due to age - child entitled to continuation.

Federal COBRA law governs employers with 20 or more employees, while state “mini-COBRA” law governs employers with fewer than 20. The laws are identical.

Individual Health

Can my health insurance carrier continue to raise my premium rates?

Yes. Missouri is an open competition state and, as such, we do not have the authority to regulate premiums on most types of health insurance. Our state relies on competition among companies to determine the premium rates. Medigap (Medicare supplement) insurance premiums are subject to some regulatory oversight.

Medigap (Medicare Supplements)

When should I apply for a Medigap policy?

When you elect coverage under Medicare Part B either due to age or disability, you have a six-month open enrollment for a Medigap policy, which guarantees you coverage with a plan and company of your choice. You may choose from the 10 standardized plans (A-J). If you do not buy a plan within your six-month open enrollment, any company you apply with can deny coverage based on your health conditions. There are some limited additional open enrollment periods available to some persons disenrolling from a Medicare HMO. Please contact us about these.

I am not satisfied with the company I have my Medigap policy with. How often can I switch companies?

Each year on your Medigap annual anniversary date you can switch companies as long as you apply for the same plan (A-J) that you currently are enrolled in and you apply for the policy within 30 days before or after your annual anniversary date.