American
Recovery and Reinvestment Act of 2009 -
Premium Assistance for Cobra
Benefits
| TITLE III - Premium Assistance for Cobra Benefits SEC. 3000. TABLE OF CONTENTS. The table of contents of this title is as follows: TITLE III—PREMIUM ASSISTANCE FOR COBRA BENEFITS Sec. 3000. Table of contents. Sec. 3001. Premium assistance for COBRA benefits. SEC. 3001. PREMIUM ASSISTANCE FOR COBRA BENEFITS. (a) PREMIUM ASSISTANCE FOR COBRA CONTINUATION COVERAGE FOR INDIVIDUALS AND THEIR FAMILIES.— (1) PROVISION OF PREMIUM ASSISTANCE.— (A) REDUCTION OF PREMIUMS PAYABLE.—In the case of any premium for a period of coverage beginning on or after the date of the enactment of this Act for COBRA continuation coverage with respect to any assistance eligible individual, such individual shall be treated for purposes of any COBRA continuation provision as having paid the amount of such premium if such individual pays (or a person other than such individual’s employer pays on behalf of such individual) 35 percent of the amount of such premium (as determined without regard to this subsection). (B) PLAN ENROLLMENT OPTION.— (i) IN GENERAL.—Notwithstanding the COBRA continuation provisions, an assistance eligible individual may, not later than 90 days after the date of notice of the plan enrollment option described in this subparagraph, elect to enroll in coverage under a plan offered by the employer involved, or the employee organization involved (including, for this purpose, a joint board of trustees of a multiemployer trust H. R. 1—342 |
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(ii) REQUIREMENTS.—An assistance eligible individual may elect to enroll in different coverage as described in clause (i) only if—
(I)
the employer involved has made a determination that such employer will permit assistance eligible individuals to enroll in different coverage as provided for this subparagraph;
(II)
the premium for such different coverage does not exceed the premium for coverage in which the individual was enrolled at the time the qualifying event occurred;
(III) the different coverage in which the individual elects to enroll is coverage that is also offered to the active employees of the employer at the time at which such election is made; and
(IV) the different coverage is not—
(aa) coverage that provides only dental,
vision, counseling, or referral services (or a
combination of such services);
(bb) a flexible spending arrangement (as defined in section 106(c)(2) of the Internal Revenue Code of 1986); or
(cc) coverage that provides coverage for services or treatments furnished in an on-site medical facility maintained by the employer and that consists primarily of first-aid services, prevention and wellness care, or similar care (or a combination of such care).
(C)
PREMIUM REIMBURSEMENT.—For provisions providing the balance of such premium, see section 6432 of the Internal Revenue Code of 1986, as added by paragraph (12).
(2)
LIMITATION OF PERIOD OF PREMIUM ASSISTANCE.—
(A)
IN GENERAL.—Paragraph (1)(A) shall not apply with respect to any assistance eligible individual for months of coverage beginning on or after the earlier of— (i) the first date that such individual is eligible for coverage under any other group health plan (other than coverage consisting of only dental, vision, counseling, or referral services (or a combination thereof), coverage under a flexible spending arrangement (as defined in section 106(c)(2) of the Internal Revenue Code of 1986), or coverage of treatment that is furnished in an on-site medical facility maintained by the employer and that consists primarily of first-aid services, prevention and wellness care, or similar care (or a combination thereof)) or is eligible for benefits under title XVIII of the Social Security Act, or
(ii)
the earliest of— H. R. 1—343
(I)
the date which is 9 months after the first day of the first month that paragraph (1)(A) applies with respect to such individual,
(II)
the date following the expiration of the maximum period of continuation coverage required under the applicable COBRA continuation coverage provision, or
(III) the date following the expiration of the period of continuation coverage allowed under paragraph (4)(B)(ii).
(B)
TIMING OF ELIGIBILITY FOR ADDITIONAL COV-ERAGE.—For purposes of subparagraph (A)(i), an individual shall not be treated as eligible for coverage under a group health plan before the first date on which such individual could be covered under such plan.
(C)
NOTIFICATION REQUIREMENT.—An assistance eligible individual shall notify in writing the group health plan with respect to which paragraph (1)(A) applies if such paragraph ceases to apply by reason of subparagraph (A)(i). Such notice shall be provided to the group health plan in such time and manner as may be specified by the Secretary of Labor.
(3)
ASSISTANCE ELIGIBLE INDIVIDUAL.—For purposes of this section, the term ‘‘assistance eligible individual’’ means any qualified beneficiary if—
(A)
at any time during the period that begins with September 1, 2008, and ends with December 31, 2009, such qualified beneficiary is eligible for COBRA continuation coverage, (B) such qualified beneficiary elects such coverage, and
(C)
the qualifying event with respect to the COBRA continuation coverage consists of the involuntary termination of the covered employee’s employment and occurred during such period.
(4)
EXTENSION OF ELECTION PERIOD AND EFFECT ON COVERAGE.—
(A)
IN GENERAL.—For purposes of applying section 605(a) of the Employee Retirement Income Security Act of 1974, section 4980B(f)(5)(A) of the Internal Revenue Code of 1986, section 2205(a) of the Public Health Service Act, and section 8905a(c)(2) of title 5, United States Code, in the case of an individual who does not have an election of COBRA continuation coverage in effect on the date of the enactment of this Act but who would be an assistance eligible individual if such election were so in effect, such individual may elect the COBRA continuation coverage under the COBRA continuation coverage provisions containing such sections during the period beginning on the date of the enactment of this Act and ending 60 days after the date on which the notification required under paragraph (7)(C) is provided to such individual.
(B)
COMMENCEMENT OF COVERAGE; NO REACH-BACK.— Any COBRA continuation coverage elected by a qualified beneficiary during an extended election period under subparagraph (A)— H. R. 1—344
(i)
shall commence with the first period of coverage beginning on or after the date of the enactment of this Act, and
(ii)
shall not extend beyond the period of COBRA continuation coverage that would have been required under the applicable COBRA continuation coverage provision if the coverage had been elected as required under such provision.
(C)
PREEXISTING CONDITIONS.—With respect to a qualified beneficiary who elects COBRA continuation coverage pursuant to subparagraph (A), the period—
(i) beginning on the date of the qualifying event, and
(ii) ending with the beginning of the period
described in subparagraph (B)(i), shall be disregarded for purposes of determining the 63-day periods referred to in section 701(c)(2) of the Employee Retirement Income Security Act of 1974, section 9801(c)(2) of the Internal Revenue Code of 1986, and section 2701(c)(2) of the Public Health Service Act.
(5)
EXPEDITED REVIEW OF DENIALS OF PREMIUM ASSIST-ANCE.—In any case in which an individual requests treatment as an assistance eligible individual and is denied such treatment by the group health plan, the Secretary of Labor (or the Secretary of Health and Human Services in connection with COBRA continuation coverage which is provided other than pursuant to part 6 of subtitle B of title I of the Employee Retirement Income Security Act of 1974), in consultation with the Secretary of the Treasury, shall provide for expedited review of such denial. An individual shall be entitled to such review upon application to such Secretary in such form and manner as shall be provided by such Secretary. Such Secretary shall make a determination regarding such individual’s eligibility within 15 business days after receipt of such individual’s application for review under this paragraph. Either Secretary’s determination upon review of the denial shall be de novo and shall be the final determination of such Secretary. A reviewing court shall grant deference to such Secretary’s determination. The provisions of this paragraph, paragraphs (1) through (4), and paragraph (7) shall be treated as provisions of title I of the Employee Retirement Income Security Act of 1974 for purposes of part 5 of subtitle B of such title.
(6)
DISREGARD OF SUBSIDIES FOR PURPOSES OF FEDERAL AND STATE PROGRAMS.—Notwithstanding any other provision of law, any premium reduction with respect to an assistance eligible individual under this subsection shall not be considered income or resources in determining eligibility for, or the amount of assistance or benefits provided under, any other public benefit provided under Federal law or the law of any State or political subdivision thereof.
(7)
NOTICES TO INDIVIDUALS.—
(A)
GENERAL NOTICE.—
(i)
IN GENERAL.—In the case of notices provided under section 606(a)(4) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1166(4)), section 4980B(f)(6)(D) of the Internal Revenue Code of 1986, section 2206(4) of the Public Health Service Act (42
H. R. 1—345 U.S.C. 300bb-6(4)), or section 8905a(f)(2)(A) of title 5, United States Code, with respect to individuals who, during the period described in paragraph (3)(A), become entitled to elect COBRA continuation coverage, the requirements of such sections shall not be treated as met unless such notices include an additional notification to the recipient of—
(I)
the availability of premium reduction with respect to such coverage under this subsection, and
(II)
the option to enroll in different coverage if the employer permits assistance eligible individuals to elect enrollment in different coverage (as described in paragraph (1)(B)).
(ii) ALTERNATIVE NOTICE.—In the case of COBRA continuation coverage to which the notice provision under such sections does not apply, the Secretary of Labor, in consultation with the Secretary of the Treasury and the Secretary of Health and Human Services, shall, in consultation with administrators of the group health plans (or other entities) that provide or administer the COBRA continuation coverage involved, provide rules requiring the provision of such notice. (iii) FORM.—The requirement of the additional notification under this subparagraph may be met by amendment of existing notice forms or by inclusion of a separate document with the notice otherwise required.
(B)
SPECIFIC REQUIREMENTS.—Each additional notification under subparagraph (A) shall include—
(i)
the forms necessary for establishing eligibility for premium reduction under this subsection,
(ii)
the name, address, and telephone number necessary to contact the plan administrator and any other person maintaining relevant information in connection with such premium reduction,
(iii) a description of the extended election period provided for in paragraph (4)(A),
(iv)
a description of the obligation of the qualified beneficiary under paragraph (2)(C) to notify the plan providing continuation coverage of eligibility for subsequent coverage under another group health plan or eligibility for benefits under title XVIII of the Social Security Act and the penalty provided under section 6720C of the Internal Revenue Code of 1986 for failure to so notify the plan,
(v)
a description, displayed in a prominent manner, of the qualified beneficiary’s right to a reduced premium and any conditions on entitlement to the reduced premium, and
(vi)
a description of the option of the qualified beneficiary to enroll in different coverage if the employer permits such beneficiary to elect to enroll in such different coverage under paragraph (1)(B).
(C)
NOTICE IN CONNECTION WITH EXTENDED ELECTION PERIODS.—In the case of any assistance eligible individual
H. R. 1—346
(or any individual described in paragraph (4)(A)) who became entitled to elect COBRA continuation coverage before the date of the enactment of this Act, the administrator of the group health plan (or other entity) involved shall provide (within 60 days after the date of enactment of this Act) for the additional notification required to be provided under subparagraph (A) and failure to provide such notice shall be treated as a failure to meet the notice requirements under the applicable COBRA continuation provision.
(D) MODEL NOTICES.—Not later than 30 days after the date of enactment of this Act—
(i)
the Secretary of the Labor, in consultation with the Secretary of the Treasury and the Secretary of Health and Human Services, shall prescribe models for the additional notification required under this paragraph (other than the additional notification described in clause (ii)), and
(ii)
in the case of any additional notification provided pursuant to subparagraph (A) under section 8905a(f)(2)(A) of title 5, United States Code, the Office of Personnel Management shall prescribe a model for such additional notification.
(8)
REGULATIONS.—The Secretary of the Treasury may prescribe such regulations or other guidance as may be necessary or appropriate to carry out the provisions of this subsection, including the prevention of fraud and abuse under this subsection, except that the Secretary of Labor and the Secretary of Health and Human Services may prescribe such regulations (including interim final regulations) or other guidance as may be necessary or appropriate to carry out the provisions of paragraphs (5), (7), and (9).
(9)
OUTREACH.—The Secretary of Labor, in consultation with the Secretary of the Treasury and the Secretary of Health and Human Services, shall provide outreach consisting of public education and enrollment assistance relating to premium reduction provided under this subsection. Such outreach shall target employers, group health plan administrators, public assistance programs, States, insurers, and other entities as determined appropriate by such Secretaries. Such outreach shall include an initial focus on those individuals electing continuation coverage who are referred to in paragraph (7)(C). Information on such premium reduction, including enrollment, shall also be made available on websites of the Departments of Labor, Treasury, and Health and Human Services.
(10)
DEFINITIONS.—For purposes of this section—
(A)
ADMINISTRATOR.—The term ‘‘administrator’’ has the meaning given such term in section 3(16)(A) of the Employee Retirement Income Security Act of 1974.
(B)
COBRA CONTINUATION COVERAGE.—The term ‘‘COBRA continuation coverage’’ means continuation coverage provided pursuant to part 6 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (other than under section 609), title XXII of the Public Health Service Act, section 4980B of the Internal Revenue Code of 1986 (other than subsection (f)(1) of such section insofar as it relates to pediatric vaccines), or section 8905a
H. R. 1—347
of title 5, United States Code, or under a State program that provides comparable continuation coverage. Such term does not include coverage under a health flexible spending arrangement under a cafeteria plan within the meaning of section 125 of the Internal Revenue Code of 1986.
(C)
COBRA CONTINUATION PROVISION.—The term ‘‘COBRA continuation provision’’ means the provisions of law described in subparagraph (B).
(D)
COVERED EMPLOYEE.—The term ‘‘covered employee’’ has the meaning given such term in section 607(2) of the Employee Retirement Income Security Act of 1974.
(E)
QUALIFIED BENEFICIARY.—The term ‘‘qualified beneficiary’’ has the meaning given such term in section 607(3) of the Employee Retirement Income Security Act of 1974.
(F)
GROUP HEALTH PLAN.—The term ‘‘group health plan’’ has the meaning given such term in section 607(1) of the Employee Retirement Income Security Act of 1974.
(G)
STATE.—The term ‘‘State’’ includes the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands.
(H)
PERIOD OF COVERAGE.—Any reference in this subsection to a period of coverage shall be treated as a reference to a monthly or shorter period of coverage with respect to which premiums are charged with respect to such coverage.
(11)
REPORTS.—
(A)
INTERIM REPORT.—The Secretary of the Treasury shall submit an interim report to the Committee on Education and Labor, the Committee on Ways and Means, and the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions and the Committee on Finance of the Senate regarding the premium reduction provided under this subsection that includes—
(i)
the number of individuals provided such assistance as of the date of the report; and
(ii)
the total amount of expenditures incurred (with administrative expenditures noted separately) in connection with such assistance as of the date of the report.
(B)
FINAL REPORT.—As soon as practicable after the last period of COBRA continuation coverage for which premium reduction is provided under this section, the Secretary of the Treasury shall submit a final report to each Committee referred to in subparagraph (A) that includes—
(i)
the number of individuals provided premium reduction under this section;
(ii)
the average dollar amount (monthly and annually) of premium reductions provided to such individuals; and
(iii) the total amount of expenditures incurred (with administrative expenditures noted separately) in connection with premium reduction under this section.
(12)
COBRA PREMIUM ASSISTANCE.— H. R. 1—348
(A)
IN GENERAL.—Subchapter B of chapter 65 of the Internal Revenue Code of 1986, as amended by this Act, is amended by adding at the end the following new section: SEC 6432 Cobra Premium Assistance
