What are my rights as a divorced spouse to continuing health insurance?
Federal law provides a right to continued health insurance coverage from “plans” covered by the federal ERISA. ¹ ERISA sets minimum standards for most voluntarily established pension and health plans ² in private industry to provide protection for individuals covered by those plans.
ERISA requires that covered plans provide participants with information about the plans features and funding; requires plans to establish a grievance and appeals process for participants to get benefits from their plans; and gives participants the right to sue for benefits and breaches of fiduciary duty.
In addition, The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers covered by certain other plans ³ and their families who lose their health benefits the right to continue their group health benefits for a limited period if that loss is the result of certain circumstances such as a voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan.
Employers must notify the health insurance plan administrator that a qualifying event has occurred within 30 days after that event (e.g. employee death, termination, reduced hours of employment or entitlement to Medicare).
A qualified beneficiary must notify the health insurance plan administrator within 60 days after divorce or legal separation or a child’s ceasing to be covered as a dependent under plan rules of that fact.
Plan participants and beneficiaries generally must be sent an election notice not later than 14 days after the plan administrator receives notice that a qualifying event has occurred. The individual then has 60 days to elect COBRA continuation coverage and 45 days after electing coverage to pay the initial continuation coverage premium.
For more information, consult the federal Department of Labor website.
¹ The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans.
² ERISA does not cover group health plans established or maintained by governmental entities, churches for their employees, or plans which are maintained solely to comply with applicable workers compensation, unemployment, or disability laws. ERISA also does not cover plans maintained outside the United States primarily for the benefit of nonresident aliens or unfunded excess benefit plans.
³ COBRA generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and their families the opportunity for a temporary extension of health coverage (called continuation coverage) in certain instances where coverage under the plan would otherwise end.