Divorce and Your Health Care: Your Legal Rights

 Posted on January 03, 2014 in Divorce

Divorce raises many questions and the continuation of health care coverage deserves an immediate answer. To alleviate concerns regarding the continuation of coverage for you and your dependents, plan on addressing your health care rights with an experienced Illinois divorce attorney early in your divorce discussions.

For those residing in Illinois, the Illinois Spousal Continuation Coverage Law (2003) provides continual coverage for up to two years if all criteria has been met. The following Q & A section summarizes your rights under the Spousal Continuation Coverage Law:

Q: Who is protected?

A. Any spouse or dependent in danger of losing health care coverage due to divorce

from the employee covered by his/her employer&s group health care plan.

Q. Which plans are covered?

A. Fully insured Illinois group, accident and HMO plans regardless of group&s size

Q. Which plans are not covered?

A. Plans defined as self-insured (union plans), or plans or trusts underwritten in other states

Q. Am I eligible to participate?

A. Yes, divorce is a qualifying event but you had to have been covered under

the plan on the day before the qualifying event.

Q. Will I be notified?

A. No, you must notify the employer and insurance company in writing within 30 days of

the qualifying event. You will be required to provide proof of dissolution of marriage.

Q. What happens next?

A.The employer will notify the insurance company within 15 days of receipt of your request.

Within 30 days of request, the insurance company is required to notify you of your

right to continuation via certified mail with return receipt requested.

Q. Do I respond to the insurance company?

A. Yes, within 30 days you need to return the notice of continuation election form

via certified mail with the return receipt requested.

Q. What is the cost?

A. If you are under 55 the cost for coverage is determined as if you were an employee.

Q. So the employer pays part of my premium?

A. No, you are responsible for the entire cost including the contribution made by the employer.

Q. What if I am over 55?

A. The cost basis stays the same as if you were under age 55 but may be adjusted

to include a 20 percent administration fee.

Q. Is there a reduction in benefits?

A. No, all benefit coverage for hospital, surgery or major medical remains the same.

Q. How long am I covered?

A. If divorce is the qualifying event and you are under the age of 55, two years.

For those 55 years and over at the time of the qualifying event, coverage extends

until Medicare eligibility.

Q. Can I lose coverage?

A. Yes, if you fail to make premium payments, you become a covered employee of

another insurance group plan or if you remarry.

Q. What are alternative options when coverage ends?

A. You can choose to convert to an individual policy at any time during the two

year continuation period.

Additional questions? If you reside in DuPage, Cook, Kane or Will counties, contact A. Traub & Associates today to schedule a consultation. Our team of dedicated attorneys are available to discuss your health care and all of your divorce related concerns.