ERISA Long term disability lawyer David M. Hicks often helps his clients with their ERISA claims. A part of understanding ERISA involves your also having knowledge about the various acts that have amended the law since it was originally passed in 1974. Each one of the amendments provides you with certain additional rights, and having a solid understanding of them may be helpful to you. The following is an overview of these major amendments as outlined by your long term disability attorney.
Passed in 1985 as an amendment to ERISA, the Consolidated Omnibus Budget Reconciliation Act, or COBRA, provides important healthcare rights to employees who have been terminated from their jobs. Before this act, an employee who had healthcare coverage through their work would lose it once they were terminated from their employment. The law was passed so that people could continue to have medical insurance after losing their jobs, as long as they did not commit gross misconduct or resign voluntarily. The employee, their spouse and their dependent child all qualify for continued coverage with COBRA for a temporary period. The qualifying event must be termination or an event such as divorce. The coverage can extend up to 18 months for the employee and up to 36 months for the child or spouse of the employee.
The Health Insurance Portability and Accountability Act, or HIPAA, was passed in 1996. The act limits the amount of time a new insurance plan can exclude preexisting conditions. Before the law, employers could exclude preexisting conditions for which the person received treatment in the previous 6 months for up to a year. The law mandates that plans give employees credit for coverage they had through their previous employers. If you lost your job, you should have received a certificate of creditable coverage that you can show your new employer to gain this benefit. If your new plan is excluding coverage for a preexisting condition despite having creditable coverage from your previous employer, you might want to talk to a long term disability attorney for help.
The Newborns’ Act
Also passed in 1996, the Newborns’ and Mothers’ Health Protection Act mandates that your health insurance plan pay for you to stay in the hospital for at least 48 hours after giving birth if you have maternity coverage. For cesarean section births, the law requires your plan to pay for a stay of up to 96 hours. If you are well enough to be discharged earlier than that, your doctor can still discharge you before the time has passed.
In 1998, the Women’s Health and Cancer Rights Act, or WHRCA, was signed into law. This important amendment provides that if you have had breast cancer for which you received a mastectomy that was paid for by your insurance company, you can opt to receive reconstructive surgery afterward. Your insurance company must also pay for the reconstructive surgery as well.
The Mental Health Parity and Addiction Equity Act, or MYPAEA, was passed in 2008. This law was intended to make your insurance plan treat mental health issues the same as they treat other health problems. If your plan provides coverage for mental health treatment, it must follow the mandates of the act. This means that your plan cannot limit the amount of treatment you receive for mental health issues any more than it limits treatment for any other condition you might have. This law is applicable if your health insurance company sells group plans to employers who have 50 or more employees working for them who opt for coverage, whether the employer is in the public or private sector. If you have been denied coverage from your insurance company for any of these important types of services, a long term disability attorney may be able to help. Your attorney will work had to make certain you are able to receive the type of coverage that is mandated for you according to the law. Some state laws in Missouri also may affect the coverage your insurance company must offer to you, and your attorney can review your plan’s policy to determine whether the company is complying with the state or federal laws controlling it. With your permission, your lawyer may talk to your insurance company to work towards resolving your lack of coverage issues and needs.
Contact a Long Term Disability Lawyer
To speak with long term disability lawyer David M. Hicks, call (314) 812-4885. We can help you with your disability case.