LTD Employee -- COBRA and HIPAA

[Guest blackacre]

I'm looking for help and your thoughts on the following scenario -- an employee has been on a medical leave for more than one year. She is receiving LTD payments. She is recently divorced and was taken off her former husband's medical policy after the divorce. She talked to the HR dept. of her employer and was told that she could go on the company medical plan. So, in March 2003, that is what she did. She has now heard from the company that allowing her coverage under the company plan was a mistake. It seems that the CBA with her union provides that employees on medical leaves can not go back on the medical plan until after a waiting period. The company said that her coverage has been terminated as of March 2003 and she must repay all the benefits she has used since then. Wondering if she could go back in time (constructively) because of the mistake about coverage and get COBRA coverage from the husband's employer. Or, under HIPAA, might her employer have to give her coverage beause she had credible coverage under the husband's plan notwithstanding the provision in the CBA? Any other ways out of this unfortunate situation? Thank you for your help.

[Jbentz]

I hate to sound dumb, but what is a CBA?

[WDIK]

It's either Collectively Bargained Agreement or Continental Basketball Association.

[Sandra Pearce]

HIPAA provides special enrollment rights to employees when they request enrollment within 30 days of specific events one of which is the loss of other group health coverage. I am not familiar with Multi-Employer or union plans, but do not believe they are excluded from the provisions of HIPAA. Therefore, if she applied for coverage within the stated period of time the plan should allow her to be enrolled. Her prior creditable coverage should prevent her from falling under any pre-existing exclusion of the union plan. With that said, how long does an employee qualify as an eligible employee under the provisions of the union plan when on medical leave? Many plans have limitations regarding eligibility related to leaves of absence.

[Guest blackacre]

CBA means Collective Bargaining Agreement. Sorry to have fallen in to lingo.

[Jbentz]

Thanks for the clarification on CBA. Based on what you said, I do not think the CBA rule applies based on that she is not going "back" on the plan until after a waiting period.

If this is the true wording in the CBA, then this not apply to this situation because she does have certain HIPAA rights for special enrollment. I would look at the special enrollment rights of the CBA. I also do not think that the CBA can be excluded from the federal laws of HIPAA.

Has she contacted a union rep?