Laws Affecting Benefits

The federal Affordable Care Act (ACA) was passed in 2010 and includes multiple provisions that take effect under different timelines. One of the elements now involving organizations with 50 or more full-time employees is a requirement to offer medical insurance to full-time employees and their children (up to age 26).

For the purposes of this law, full-time employees are those who work 30 or more hours per week. The Office of Human Resources has reviewed university records to identify all individuals whose average weekly service totals 30 hours. The university has communicated with those individuals and informed them that they are eligible for medical insurance.

If you believe that you are eligible for medical insurance and have not received a communication from the university, please email AskHR@case.edu.

Some individuals not eligible for medical coverage at this time may become eligible because of changes in their duties and/or average weekly work hours. In addition, new employees may qualify for medical insurance if their initial terms of hire involve working 30 or more hours per week.

Additional information about the Affordable Care Act may be found at healthcare.gov. If you have questions about your medical insurance eligibility at Case Western Reserve, please email AskHR@case.edu.

If you terminate your employment or reduce your hours of employment, you will usually have the right to temporarily continue your health and dental coverage through Case Western Reserve University.

COBRA requires that most employers sponsoring group health plans offer employees and their families the opportunity for a temporary extension of health and dental coverage (called "COBRA coverage") at group rates in certain qualifying instances where coverage under the plan would otherwise end. If you are an employee of Case Western Reserve and are covered by one of the group health and dental plans, you have a right to choose COBRA coverage if you lose your group health coverage because of a reduction in your hours of employment or the termination of your employment (for reasons other than gross misconduct on your part).

Spouse

If you are the spouse of an employee covered by one of the university's basic health plans, you have the right to choose COBRA coverage for yourself if you lose group health coverage due to any one of the following four qualifying events:

• The death of your spouse
• A termination of your spouse's Case Western Reserve employment (for reasons other than gross misconduct) or reduction in your spouse's hours of employment that renders him/her ineligible to continue group medical and dental coverage
• Divorce or legal separation from your spouse
• Your spouse becomes entitled to Medicare

Dependent

If you are the dependent child of a former Case Western Reserve employee and covered by a group health or dental plan sponsored by Case Western Reserve, you have the right to choose COBRA coverage for yourself if your group health and dental coverage stops due to any one of the following five qualifying events:

• The death of a parent
• A termination of your parent's Case Western Reserve employment (for reasons other than gross misconduct) or reduction in your parent's hours of employment with Case Western Reserve renders them ineligible to continue group medical and dental coverage.
• Parents divorce or legally separate
• A parent becomes entitled to Medicare.
• The dependent child attains the age of 26.

If you choose COBRA coverage, Case Western Reserve will provide the same coverage which is being provided to all similarly situated employees and family members. Under the law, the employee of a family member has the responsibility to inform Benefits Administration of a divorce, legal separation, or child losing dependent status under one of the plans. The University must internally identify the employee's death, termination of employment, reduction in hours or Medicare eligibility.

When Benefits Administration is advised that a qualifying event has occurred, they will notify you that you have the right to choose COBRA coverage. Under the law, you have 60 days from the date you would lose coverage due to one of the qualifying events described above to inform Benefits Administration that you want COBRA coverage.

If you do not choose COBRA coverage, your group health insurance coverage will end as of the date of the qualifying event. If you do choose COBRA coverage, the university is required to give you coverage which, as of the time coverage is being provided, is identical to the coverage provided under the plan to similarly situated employees of family members.

The law requires that you be afforded the opportunity to maintain coverage for up to 36 months unless you lost group health coverage because of a termination of employment or reduction in hours. In that case, the required COBRA coverage period is 18 months.

If you are disabled at the time of the original qualifying event, you may be eligible for a total of 29 months of COBRA coverage, provided that a determination letter from the Social Security Administration is presented as evidence before the 18-month COBRA coverage period has expired.

The law also provides that your COBRA coverage may be cut short for any of the following five reasons:

• The university no longer provides group health and dental coverage to any of its employees.
• The premium for your COBRA coverage is not paid (payment must be received no later than 30 days after it is due).
• You become covered under another group health plan as an employee or otherwise.
• You become entitled to Medicare.
• You were divorced from a covered employee and subsequently remarry and are covered under your new spouse's group health plan.

You do not have to show that you are insurable to choose COBRA coverage. You will be responsible for paying both the employer and the employee's premiums to receive this coverage plus two percent to cover administrative costs. The law also says that, at the end of the 18-month or 36-month coverage period, you must be allowed to enroll in an individual conversion health plan provided by the particular carrier.

This law applies to any of the university health plans beginning on June 1, 1987, under §10002(d) of COBRA as enacted April 7, 1986 (Public Law 99-272, Title X), and as amended. If you have any questions about the law, please contact Case Western Reserve University, HR Service Center, 320 Crawford Hall, AskHR@case.edu, or 216.368.6964.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 protects the privacy and security of certain health information.

The Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. This Notice will tell you about the ways in which Case Western Reserve University employee welfare benefits plan(s) (collectively “the Plan”) protects, uses and discloses your protected health information (“PHI”). This Notice also describes your rights and certain obligations we have regarding the use and disclosure of PHI.

PHI means any information, transmitted or maintained in any form or medium, which Case Western Reserve creates or receives that relates to your physical or mental health, the delivery of health care services to you or payment for health care services and that identifies you or could be used to identify you. We maintain your PHI in a record we create of the services and items you receive from Case Western Reserve. This Notice applies to all of those records created, received or maintained by Case Western Reserve.

A copy of the Notice of Privacy Practices is available to all members of the Group Health Plan. You can obtain a copy of the Notice of Privacy Practices by:

• Printing the Notice of Privacy Practices,
• Obtaining a paper copy from the HR Service Center - Crawford Hall, Room 320
• Contacting Benefits Administration at AskHR@case.edu or 216.368.6964

Also known as “Janet’s Law,” the Women's Health and Cancer Rights Act (WHCRA) of 1998 requires health care benefit plans to provide certain coverage following a mastectomy. The law also requires annual notification to all plan participants and their covered beneficiaries.

Case Western Reserve University group health plans provide coverage for mastectomies. As part of this coverage, the plans also cover procedures necessary to effect reconstruction of the breast on which the mastectomy was performed, as well as the cost of prostheses (implants, special bras, etc.).

Coverage is also provided for physical complications of all stages of mastectomy, including lymphedemas, as recommended by the attending physician of any patient receiving plan benefits in connection with the mastectomy. Health plans also cover any necessary surgery and reconstruction of the breast on which a mastectomy was performed in order to produce a symmetrical appearance. This coverage is subject to the same deductibles and co-insurance that apply to mastectomies under current terms.

Please refer to your particular benefit plan booklet regarding deductible and co-insurance requirements for mastectomies.