Look for wellness programs
A growing number of employers are implementing wellness programs
that encourage employees to exercise, quit smoking, and lead a healthier lifestyle in general.
The Health Insurance Portability and Accountability Act (HIPAA ) and the ACA support group
health insurance programs in adopting wellness programs and prohibit discrimination
against employees and dependents on the basis of health status.
These programs often include incentives, such as cost savings, and also promote health.
Familiarize yourself with your ” SPD ” or ” SBC” to find out if your health plan has health program(s).
If there is one, find out what kind of promotion is offered and what you need to do to get it.
Learn how to appeal a denial of payment for medical services
Understand your program’s procedures for applying for benefits and challenging program decisions.
Pay attention to deadlines – make sure applications and appeals are submitted on time and that the program makes decisions within the deadlines.
Keep records and copies of all correspondence. Check your health
insurance package and SPD to see who is responsible for resolving issues with claims.
Contact EBSA for help if the program is not responding to your complaint.
Review your health insurance due to a change in marital status
You may need to change your health insurance plan after certain life events,
such as marriage, divorce, the birth or adoption of a child, the death of a spouse,
or a child leaving a parent’s health insurance program due to age. You,
your spouse, and dependent children may be eligible for special enrollment in other employer health plans or the Marketplace.
Even if there are no changes in life, the employer must provide you with information
about the possibilities of changing health insurance or switching to another program.
If you are considering special registration, act quickly. You have 30 days after a life event to request
special enrollment in another employer’s health plan or 60 days to select a program in the Marketplace.
9. Be aware that job changes and other circumstances at work can affect your health insurance.
If you change employers or lose your job, you may need to look for another health insurance plan.
you have a new job, consider enrolling in a new employer program.
you make or lose a job, you may be eligible for special enrollment in a spouse’s employer-sponsored program or the Health Insurance Marketplace.
According to the Consolidated Omnibus Budget Reconciliation Act – COBRA), you, your spouse,
and your dependent children may be eligible for continued coverage under a program funded by your former employer.
This insurance is temporary (usually 18 to 36 months) and you may have to pay the full insurance premium and a 2% administration fee.
Collect information about insurance coverage options and compare them.
Learn about the timing of your insurance decision and find out when your new coverage will start.
Planning for retirement
Before you retire, find out which health care programs, if any, will be available to you and your spouse.
Check with your employer’s Human Resources Department, your union, or your program administrator.
Read ” SPD ” and other program documents. Make sure that these sources
do not contain conflicting information about the benefits you are entitled to or the circumstances under which they can be changed or canceled.
With this information, you can make other important decisions, such as enrolling in Medicare or purchasing Medigap coverage.
(did you are eligible). If you want to retire before you qualify for Medicare and
your employer doesn’t provide medical benefits upon retirement, think about how you can get health insurance.
You have the following options: Enroll in your employer program or the Marketplace Health Plan,
or temporarily continue coverage with your employer by selecting the COBRA program.
Retirement planning involves planning for health insurance in retirement.
For more information, see Taking the Mystery Out of Retirement Planning (see overleaf).
