New York COBRA- does it exist?

[Guest PALAWYER]

What are (if there are any?) the State Law requirements in New York for continuation of health coverage- some materials I have indicate that there is a "mini-cobra" law in New York. Does anyone know? Do you have citations?

Thank you

[Larry M]

From RIA:

¶113,734. New York.

New York directs that all group accident and health insurance contracts 28 and all group contracts issued by a hospital service, health service, or medical expense indemnity corporation 29 must permit employees and their dependents to continue coverage, without evidence of insurability, when all or any portion of the insurance ceases because of the employee's termination of his job or membership in an eligible class. 30 Coverage must begin within 45 days after termination of coverage, and after application and payment of the first premium. It must include the minimum standards for basic hospital and medical or major medical coverage included in the insurance department regulations. If the insurer does not issue a major medical contract, coverage must include a comprehensive or comparable type of coverage commonly sold. 31 The benefits may continue for 18 months or, if earlier, the end of the period for which premium payments were made, if the employee fails to make a timely payment, or the

date when the group policy is terminated or an employer terminates participation in a group policy. However, where the policy is replaced by similar coverage under another group policy, the employee has the right to become covered under the other policy for the balance of the 18 months. 32 Continuation is not available for any individual who is covered or could be covered by Medicare or another insurer that does not exclude or limit preexisting conditions, but an employee who receives Social Security disability benefits because the employee is disabled at the time of termination may continue insurance coverage for 29 months after the date that the employee's coverage would otherwise have been terminated. If the employee ceases to be disabled, coverage terminates the later of (1) 18 months after normal termination of coverage or (2) the month that begins more than 31 days after disability benefits terminate. 33

28. NY CLS Ins Law § 3221(m) .

29. NY CLS Ins Law § 4305(e) .

30. NY CLS Ins Law § 3221(m)(4) ; NY CLS Ins Law § 4305(e)(4) .

31. NY CLS Ins Law § 4305(e)(1) .

32. NY CLS Ins Law 3221(m)(4) ; NY CLS Ins Law § 4305(e)(4) .

33. NY CLS Ins Law § 3221(m)(1) ; NY CLS Ins Law § 4305(e)(1) ; NY CLS Ins Law § 4305(e)(4)(D) .

An employee who is determined to have been disabled at the time of termination of employment may obtain continuation coverage for 29 months from the date that the employee's benefits would otherwise have terminated, unless the employee's disability ceases to exist. If the employee is no longer disabled, continuation coverage terminates on the later of 18 months after benefits would have terminated under the initial group policy, or the month that begins more than 31 days after the ate of a Social Security determination that the employee is no longer disabled. 34

34. NY CLS Ins Law § 3221(m)(4)(D) ; NY CLS Ins Law § 4304(k)(4)(D) .

Continuation coverage for an eligible dependent of an employee must continue until 36 months after the date that benefits under the policy would otherwise have terminated due to the death of the employee, the eligibility of the employee for Medicare, divorce or legal separation, or the dependent child ceasing to qualify as a dependent child under the initial group policy. 35

35. NY CLS Ins Law § 3221(m)(4)© ; NY CLS Ins Law § 4304(k)(4)© .

In order to obtain a continuation of coverage, the employee must send a request and the first premium payment within 60 days of the date of termination or, if later, the date that he was given notice of his right to continuation by the employer or the group policyholder. Demand for premium payments cannot be more frequent than on a monthly basis and the amount of the premium cannot exceed 102% of the group rate under the group contract. 36

36. NY CLS Ins Law § 3221(m)(2) ; NY CLS Ins Law § 3221(m)(3) ; NY CLS Ins Law § 4305(e)(2) ; NY CLS Ins Law § 4305(e)(3) .

An employer who receives notice that the employee has elected to exercise the continuation right must remit the premiums to the insurer no later than 30 days after the receipt of premiums from employee and must provide evidence to the employee that the premium has been remitted.

37 If the policyholder fails to comply with the law, it may forfeit a sum up to $5,000, to be recovered by the commissioner in a civil action.

38 In addition, the policyholder is liable in a civil action brought by the employee for appropriate damages, including reimbursement for medical expenses not covered by the policyholder's in- surer because of the failure to remit the premium.

39 37. NY CLS Labor Law § 217(6) .

38. NY CLS Labor Law § 217(7)(a) .

39. NY CLS Labor Law § 217(7)(B) .

An eligible dependent of an employee may continue benefits until the date 36 months after the date that the dependent's benefits would have otherwise terminated because of (1) the death of the employee, (2) the divorce or legal separation of the employee from his spouse, (3) the employee becoming entitled to Medicare benefits, or (4) a dependent child ceasing to be a dependent child under the insurance contract. 40

40. NY CLS Ins Law § 4305(e)(4)© .

In addition, an employer must notify any employee terminated from employment, in writing, of the exact date of termination as well as of the exact date of cancellation of employee benefits connected with the termination. In no case may the termination notice be provided more than five working days after the termination date. Failure to notify an employee of cancellation of accident or health insurance subjects the employer to an additional penalty under NY CLS Labor Law §217 (footnotes 17.1-17.3). 41

41. NY CLS Labor Law § 195(6) .

[Guest PALAWYER]

Thank you very much indeed!