§ 764j. Mini-COBRA small employer group health policies
Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 40 P.S. InsuranceEffective: July 9, 2010
Effective: July 9, 2010
40 P.S. § 764j
§ 764j. Mini-COBRA small employer group health policies
(a) A group policy in effect or delivered or issued for delivery in this Commonwealth on or after the effective date of this section by an insurer which insures employes and their eligible dependents for hospital, surgical or major medical insurance shall provide that covered employes, or eligible dependents whose coverage under the group policy would otherwise terminate because of a qualifying event, shall be entitled to continue their hospital, surgical or major medical coverage under that group policy subject to the following terms and conditions:
(1) Continuation shall only be available to a covered employe or eligible dependent who has been continuously insured under a group policy, or for similar benefits under any group policy which it replaced, during the entire three-month period ending with such termination. If employment is reinstated during the continuation period, then coverage under the group policy must be reinstated for the covered employe and any eligible dependents who were covered under continuation.
(iii) Is or could be covered by any other insured or uninsured arrangement which provides hospital, surgical or major medical coverage for individuals in a group and under which the person was not covered immediately prior to such termination, excluding the Medical Assistance Program established under the act of June 13, 1967 (P.L. 31, No. 21),1 known as the “Public Welfare Code,” the children's health care program established under Article XXIII2 or the Adult Basic Coverage Insurance Program established under chapter 13 of the act of June 26, 2001 (P.L. 755, No. 77),3 known as the “Tobacco Settlement Act,” and any successors thereto.
(4)(i) The group policy shall provide notice to the policyholder of the rights provided under this section. Unless already provided in the group policy, an insurer who has issued a group policy in effect as of the effective date of this section shall provide such notice to the policyholder within forty-five days of the effective date.
(ii) The employer of a covered employe under a group policy must notify the administrator or its designee, the covered employe and the insurer of a qualifying event within thirty days of the qualifying event. Notice to the covered employe shall include notice of the rights set forth in this section.
(iii) Each covered employe or eligible dependent shall notify the administrator or its designee of its election of continuation coverage under this section within thirty days of notice under subparagraph (ii). The coverage shall be effective as of the date of the qualifying event and shall be the same as the coverage in effect at the time of the qualifying event or any replacement coverage.
(iii) Nothing in this section shall require the employer to contribute to the deductible of the employe holding a health savings account as defined in the Internal Revenue Code of 1986 (Public Law 99-514, 26 U.S.C. § 223 (d)) or other medical spending account as a component of the group policy after the termination date as long as scheduled payments have been made.
(ii) if, during the pendency of a covered employe's or dependent's receipt of continuation of coverage under a group policy, the department publishes a notice in the Pennsylvania Bulletin stating that a Federal premium assistance program is in existence, including premium assistance under the American Recovery and Reinvestment Act of 2009 (Public Law 111-5, 123 Stat. 115) or any successor extension act, the maximum number of months for which the program would make premium assistance available to the covered employe or eligible dependent because of the qualifying event, taking into account all prior months of the continuation of coverage from and after the date of the qualifying event.
(b) A covered employe shall be entitled to obtain a conversion policy as stated in section 621.2.4 The right to a converted policy pursuant to this act for a covered employe or eligible dependent entitled to continuation of coverage under this act shall commence upon termination of the continued coverage provided for under this act.
(d) In the case of a qualifying event consisting of the involuntary termination of the covered employe's employment occurring on or after the effective date of this section and before January 1, 2010, or such other date as specified by any amendment to or successor of Section 3001 of Division B, Title III of the American Recovery and Reinvestment Act of 2009 (Public Law 111-5, 123 Stat. 115),5 a covered employe or eligible dependent shall be entitled to premium assistance as provided in Section 3001 of Division B, Title III of the American Recovery and Reinvestment Act of 2009, pursuant to the procedures and requirements set forth therein.
(1) Persons who are not subject to the continuation and conversion provisions set forth in Title 1, Subtitle B, Part 6 of the Employee Retirement Income Security Act of 1974 (Public Law 93-406, 29 U.S.C. § 1161 et seq.) or Title XXII of the Public Health Service Act (Public Law 99-272, 42 U.S.C. § 300bb-1 et seq.).
(2) “Covered employe” means an individual who is or was provided coverage under a group policy by virtue of the performance of services by the individual for one or more persons maintaining the policy, including as an employe defined in Section 401(c)(1) of the Internal Revenue Code of 1986 (Public Law 99-514, 26 U.S.C. § 401(c)(1)). Such term includes employes and members as those terms are used in section 621.2.
(5) “Insurer” means a company or health insurance entity licensed in this Commonwealth to issue any health, sickness or accident policy or subscriber contract or certificate or plan that provides medical or health care coverage by a health care facility or licensed health care provider that is offered or governed under article XXIV6 or other provision of this act or any of the following:
(i) The act of December 29, 1972 (P.L. 1701, No. 364),7 known as the “Health Maintenance Organization Act.”
(vi) A proceeding in a case under 11 U.S.C. (relating to bankruptcy), with respect to the employer from whose employment the covered employe retired at any time. In the case of an event described in this subparagraph, a loss of coverage includes a substantial elimination of coverage with respect to an eligible dependent within one year before or after the date of commencement of the proceeding.
1921, May 17, P.L. 682, No. 284, § 635.4, added 2009, June 10, P.L. 5, No. 2, § 1, effective in 30 days [July 10, 2009]. Amended 2010, July 9, P.L. 362, No. 51, § 5, imd. effective.
62 P.S. § 101 et seq.
40 P.S. § 991.2301 et seq.
35 P.S. § 5701.1301 et seq.
40 P.S. § 756.2.
26 U.S.C.A. § 6432 note.
40 P.S. § 991.2401 et seq.
40 P.S. § 1551 et seq.
40 P.S. § 764j, PA ST 40 P.S. § 764j
Current through 2023 Regular Session Act 32. Some statute sections may be more current, see credits for details.
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