Effective Date: January 1, 2014

Previous Policy

The following definitions apply to terms used in this section and throughout this policy manual.

1. “COBRA coverage” is a temporary extension of employer health insurance coverage whereby a person who loses coverage under the employer’s group health plan can remain covered for a certain length of time. The person is usually required to pay both the employee and the employer share of the premium, with up to an additional 2% for administrative costs.

2. “Enrolled” means a person is signed up for and receiving health insurance coverage.

3. “Group health plan” is an employee welfare benefit plan that provides medical care to employees or their dependents directly or through insurance, reimbursement, or otherwise.

4. “Health insurance coverage or plan” means a benefit plan offered by a health insurance issuer which provides for coverage of medical care under any hospital or medical service plan contract, or health maintenance organization contract. The coverage may be a group plan or an individual insurance plan. A health insurance issuer is a company licensed to sell insurance under state law.

5. “Limited coverage plans” are insurance plans which only provide medical care for a single type of service or specific disease, under special or specific circumstances, or where the medical care is secondary to the primary purpose of the insurance. Examples of limited coverage plans are found in Sec. 220-3 .

6. “Medical care” means amounts paid for the diagnosis, cure, mitigation, treatment or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body; transportation primarily for and essential to medical care; and amounts paid for insurance covering medical care.

7. “Open enrollment periods” are times a person may enroll in a health insurance plan if he or she did not enroll at the earliest possible time.

8. “Waiting period” is a period of time that must pass before an individual who is enrolled in an insurance plan can receive coverage for services under the plan. For example, the individual may enroll in the insurance plan on their first day of employment, but coverage under the policy does not start until the first day of the next month.

A waiting period is not a period of time that an employer requires the person to be employed before they are allowed to enroll in a group health insurance plan. For example, an employer requires their employees to work for them for six months before they are eligible to enroll in the insurance. (See section 220-9 for information about CHIP eligibility during this time.)