New Effective Date And Special Enrollment Notices Under New York State Insurance Law 36-Month COBRA Extension

December 2009

On July 29, 2009, New York State amended its insurance law to extend continuation coverage for loss of coverage due to termination of employment or a reduction in work hours under New York group health insurance contracts from 18 months to 36 months. On November 19, 2009, New York State amended this statute by providing for a new effective date of November 1, 2009, and a special enrollment period described below.

The original legislation applies to New York State "mini-COBRA" policies and extends federal continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended ("COBRA) and was originally effective for group health contracts issued, modified or renewed on or after July 1, 2009. This legislation applies to group health coverage offered under insurance contracts subject to New York State insurance law but does not extend to group health plans that are self-insured. (For a more detailed description of these changes to New York State law, see EBG's August 12, 2009, Client Alert, "New York State Insurance Law Extends Continued Health Coverage From 18 Months to 36 Months and Dependent Health Coverage Through Age 29".)

On November 19, 2009, New York State amended the 36-month COBRA extension by providing for a new effective date of November 1, 2009, regardless of when the group health contract was issued, modified or renewed. There is no special notice requirement for this change.

This new legislation also provides for a 60-day special enrollment period for individuals whose COBRA coverage expired between July 1, 2009, and November 1, 2009. Those individuals must be given the opportunity to elect an extension of their coverage for an additional 18 months, but totaling no more than 36 months of total coverage. The 60-day special enrollment period begins upon receipt of a notice of special enrollment from the insurer. If a special enrollment election is made, the COBRA extension is effective prospectively no later than 30 days after the election and payment of the first premium. Any gap in coverage between July 1, 2009, and the effective date of coverage through the special enrollment election will be disregarded for purposes of determining if a pre-existing condition waiting period is applicable and will not reduce the 36 months of total coverage available. Insurers must make "reasonable efforts" to provide notices of special enrollment within 30 days of the enactment of the statute (i.e., by December 19, 2009). If notice is not received, the special enrollment period extends through May 19, 2010.

For more information about this Client Alert, please contact:

Gretchen Harders
New York
212-351-3784
[email protected]

Michelle Capezza
New York
212-351-4774
[email protected]

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