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U.S. Department

Employee Benef

January 2013 

Impo

The Departme

Retirement In

401(k) plans) 

health coverag

Act (COBRA) 

job loss and it

When facing 

oss of health

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the individua

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health plan, C

employers wi

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plan), but gen

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coverage. (No

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qualified indi

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certain people

t Sh

t of Labor

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ent of Labor’s

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ts effect on wo

job loss or a

h coverage. T

en they lose t

rollment in 

ouse’s emplo

l and his/her 

enrollment p

lity for other

later than the 

usually the mo

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COBRA cont

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efore (and is

nerally the co

a notice regar

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roup health p

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s 18 months,

erage Thro

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(for low-inco

ogram (for ch

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ministration 

ormation W

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s Employee B

y Act of 1974

plans (includ

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orkers’ health

a reduction in

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their jobs: 

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periods. How

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ome individu

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d plan), speci

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the first mon

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s a spouse’s p

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Retiremen

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 enroll in a p

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individual an

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cost for cover

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COBRA, he/s

plan, until a

ollment in an

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Governments

viduals with s

ies), or Medi

renal disease

Know to P

nt Benefit

ration (EBSA)

retirement pla

life insurance

nsolidated Om

bility Act (HI

benefits. 

know their op

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up health cov

nt in that plan

plan for which

ent must be r

s requested, c

 your request

oyer continue

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nd his/her fam

ge may be hi

rage under sp

vidual health 

erage. After t

n available re

/she won’t be

all COBRA c

nother plan p

mstances. 

ealth coverag

s. Information

special needs

icare (for peo

e), is availabl

Protect th

ts 

) administers 

ans (including

e plans). ERI

mnibus Budg

IPAA). This fa

ptions ahead 

uals who are l

verage is ava

n should be c

h they are ot

requested wit

coverage is re

t for enrollm

es to operate 

hich generally

mily to conti

gher than wh

pecial enrollm

insurance co

this notice is 

etroactive to t

e eligible for 

coverage ava

promptly.) C

ge may be av

n on governm

s), State Chil

ople aged 65 

le through yo

heir Health

the Employee

g profit shari

ISA also inclu

get Reconcilia

fact sheet focu

of time to pr

losing their h

ailable (for ex

onsidered. It

therwise eligi

thin 30 days 

equired to be

ment. This typ

and offer a g

y applies to 

nue the same

hat the indivi

ment in a spo

overage. The 

provided, th

the loss of 

special enro

ailable is exh

OBRA cover

ailable to cer

ment program

ldren’s Healt

and over, an

our State insu

h

e

ng and 

udes the 

ation 

uses on 

revent 

health 

xample 

t allows 

ible, 

of 

e made 

pe of 

group 

e group 

idual 

ouse’s 

plan 

he 

ollment 

austed. 

rage 

rtain 

ms such 

th 

nd for 

urance 
department, by visiting www.insurekidsnow.gov on the Web, or by calling the U.S. Department of Health 

and Human Services, Centers for Medicare and Medicaid Services at 1-800-MEDICARE. 

You may also want to contact your State insurance commissioner's office to find out about your State's 

high risk pool for people who cannot otherwise get health benefits. Or visit 

http://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/index.html for 

information on the Federal program -- the Pre-Existing Condition Insurance Plan. 

Private, Individual Health Insurance. The last option for an individual to consider is private 

individual health insurance coverage. Individuals may qualify for guaranteed access to such coverage, 

without any pre-existing condition exclusions, if: 

 They had health coverage for at least 18 months without a significant break in coverage 

(generally a break in coverage of 63 days or more) and the most recent period of coverage was 

under a group health plan; 

 Group coverage was not terminated because of fraud or failure to pay premiums; 

 They either were not eligible for COBRA continuation coverage (or similar State program), or 

if eligible for COBRA coverage (or similar State program), they both elected and exhausted 

COBRA coverage; and 

 They are not eligible for other health coverage. 

Even if they do not meet these criteria, they may still be able to obtain coverage. The cost of individual 

coverage is often higher than similar coverage under a group health plan obtained through special 

enrollment in another group plan or COBRA. More information on individual health coverage is available 

from your State insurance commissioner or the Department of Health and Human Services, Centers for 

Medicare and Medicaid Services at 410-786-1565 or www.cms.gov. 

When considering health coverage options, individuals should examine the scope of the coverage 

(including benefit coverage and limitations, visit limits, and dollar limits), premiums, cost sharing 

(including co-payments and deductibles), and waiting periods for coverage. For information on the 

coverage through a particular group health plan, the worker should call the plan administrator and request a 

copy of the plan’s summary plan description. 

Note: The Affordable Care Act (ACA) adds important protections related to employment based group 

health plans that will improve health coverage for you and your family. Many of these protections are 

available now including extending dependent coverage until age 26, prohibiting pre-existing condition 

exclusions for children under 19, and banning lifetime limits on coverage for essential health benefits. 

Additional protections will be available in 2014. This publication does not reflect the provisions of the 

Affordable Care Act. For more information, visit the Employee Benefits Security Administration’s ACA 

Web page at www.dol.gov/ebsa/healthreform. 

Retirement Benefits. ERISA provides rules for those responsible for the management and oversight of 

your retirement plan. It also provides you with rights and responsibilities, including specific rights to plan 

information. If you lose your job, make sure you have a copy of your plan’s current summary plan 

description (SPD) and your individual benefit statement. If not, request a copy. The SPD tells you if and 

when you can collect your benefits or how to roll over your 401(k) account to a new employer’s plan or to 

an IRA (if your old plan permits you to do so). The individual benefit statement lets you monitor your 

account balance and is an important statement to keep on file. If your retirement savings remain in your 

former employer’s plan, keep current on any changes the company makes, including changes of address, 

employer name, or mergers and give the plan any changes to your contact information. If your benefits are 

in a traditional pension plan and your plan ends without enough money to pay the promised benefits, the 
Pension Benefit Guaranty Corporation will assume responsibility as trustee of the plan and pay benefits up 

to a maximum guaranteed amount set by law. 

The free publications listed below provide more information: 

o Retirement and Health Care Coverage...Questions and Answers for Dislocated Workers 

o Your Health Plan and HIPAA...Making the Law Work for You 

o An Employee's Guide to Health Benefits under COBRA 

o What You Should Know About Your Retirement Plan 

They are available on EBSA’s Web site or by calling toll-free 1-866-444-3272 to request copies. If you 

have questions about these options, you can contact one of our Benefits Advisors electronically at 

www.askebsa.dol.gov or by calling 1-866-444-3272. 

For more information on the Pension Benefit Guaranty Corporation, visit www.pbgc.gov or call 

1-800-400-7242. 

This fact sheet has been developed by the U.S. Department of Labor, Employee Benefits Security Administration, 

Washington, DC 20210. It will be made available in alternative format to persons with disabilities upon request: Voice 

telephone: 202-693-8664; TTY: 202-501-3911. In addition, the information in this fact sheet constitutes a small entity 

compliance guide for purposes of the Small Business Regulatory Enforcement Fairness Act of 1996.