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The purpose of this brochureis to help families learn what rights and protections may benefit their children with disabilities, chronic illnesses or other special needs under federal laws concerning health insurance and leave benefits at work.The U.S. Department of Labor is responsible for oversight and accountability in the application of the

laws presented in this brochure.  Informational bulletins and fact sheets can be obtained from the DOL and are available through the Internet at: www.dol.gov/pwba/health.htm

 Families should also check

with their state’s insurance authority to find out how state specific rules relate to the laws discussed here. Some states have chosen to expand certain provisions in the U.S. code and some have elected not to participate in a few optional provisions. State Consumer Guides for Getting and Keeping Health Insurance are available from the Institute for Health Care Research and Policy, located at George Washington University. The consumer guides can be downloaded from:

www.healthinsuranceinfo.net

 Where to find more information:

Agency for Healthcare Research & Quality www.ahcpr.gov 

Families USA www.familiesusa.orgGeorge Washington University Institute for Health Care Research and Policy www.healthinsuranceinfo.net/National Health Law Project www.healthlaw.orgPACER Center, Inc. Health Information & Advocacy Center(phone: 952-838-9000) www.pacer.org3411 Candelaria N.E., Suite MAlbuquerque, NM 87107Toll free: 1-888-835-5669Phone: (505) 872-4774Fax: (505) 872-4780Email: kidshealth@familyvoices.orgwww.familyvoices.orgHealth Insurance Lawsat Work and Related RightsA Guide forFamiliesof Children withSpecial Health Care Needsin NORTH DAKOTA, contact: Health Insurance LawsCOBRA: The ConsolidatedOmnibus Budget Reconciliation Act of1985 helps workers and their familieskeep their group health coverageduring times of voluntary orinvoluntary job loss, reduced workhours, transition between jobs and incertain other cases including divorce ordeath of a covered employee, ortransition from dependent child status.COBRA generally applies to grouphealth plans offered by employers with20 or more employees. The coveredemployee pays for the continuationbenefits, which generally last up to 18months. This 18-month period may beextended for up to 36 months in caseswhere a qualified beneficiary meetsspecific disability criteria.HIPAA: The Health InsurancePortability and Accountability Act of1996 offers protections for workersthat improve portability and continuityof health insurance coverage. HIPAAprovides the following benefits andmore: limits exclusions for preexistingmedical conditions; prohibitsdiscrimination in enrollment and inpremiums charged to employees andtheir dependents based on healthstatus-related factors; preserves thestates’ role in regulating healthinsurance, including the states’authority to provide greater protectionsthan those available under federal law;and improves disclosure about grouphealth plans. Dependent children maybe eligible for a special enrollmentperiod under HIPAA provisions.ERISA: The Employee RetirementIncome Security Act of 1974 governshealth benefit plans sponsored byprivate sector employers. UnderERISA, workers and their families areentitled to receive a summary plandescription (SPD) that givesinformation about the plan, whatbenefits are available under the plan,the rights of participant andbeneficiaries under the plan, and howthe plan works, including the appeals

process.

 MHPA: The Mental Health ParityAct of 1996 established that lifetime andannual dollar limits on mental healthbenefits must be equal to any lifetimeand dollar limits set on the medical/surgical benefits offered by group healthplans, insurance companies and HMOs.The MHPA does not require health plansto offer mental health benefits and it doesnot apply to benefits for substance abuseor chemical dependency. Also, healthplans may set policies for cost-sharingand determine the amount, duration andscope of mental health benefits it offers

to plan subscribers.

 Leave BenefitsFMLA: The Family MedicalLeave Act of 1993 grants coveredemployees up to 12 work weeks ofunpaid leave during any 12-monthperiod for one or more of the followingreasons: for the birth and care of thenewborn child of the employee; forplacement with the employee of a sonor daughter for adoption or foster care;to care for an immediate familymember (spouse, child, or parent) witha serious health condition; or to takemedical leave when the employee isunable to work because of a serious

health condition.

 Other ConsiderationsMarriage, divorce, birth or adoption of achild, or the death of a spouse are lifeevents that may signal a need to reviewand possibly change your health benefits.There are ways to learn about the qualityof health plans and the service providerswithin those plans. Look for thesequality measures and compare planswhen given a choice of plans. A goodsource for this information is the booklet:Your Guide to Choosing Quality HealthCare, which is available at:

www.ahcpr.gov/consumer

 Acknowledgments: Family Voices of TN;Institute for Health Care Research and Policyat George Washington University; Pensionand Welfare Benefits Administration, US

Dept. of Labor: 1-866-4-USA-DOL

 

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