WORK 

CHANGES

REQUIRE HEALTH

CHOICES

PROTECT YOUR RIGHTS

EMPLOYEE BENEFITS SECURITY ADMINISTRATION

UNITED STATES DEPARTMENT OF LABOR
Work Changes 

Require Health 

Choices... Protect 

Your Rights

Opportunities and 

setbacks are part of life 

—- especially when it 

comes to work. Learn 

how changes in 

employment status can affect health 

coverage. Whether you are thinking about 

changing employers, have landed a new job, 

or lost or retired from one, find out today 

how to have the health benefits you might 

need tomorrow. Know your rights. Exercise 

your options.

Your First Job

Starting your very first job? Your new 

employer should provide you with a notice of your 

health coverage options. Consider enrolling in 

your employer’s health care plan. If your employer 

offers more than one option – an HMO plan, a 

preferred provider option, and a fee-for-service 

plan, for example – compare each to your needs 

and preferences before making a decision. Ask 

for copies of two key documents – the Summary 

Plan Description (SPD) and the Summary of 

Benefits and Coverage (SBC) – to get details about 

covered benefits and costs. Find out what type of 

plan you have, how it works, and what eligibility 

requirements you may have to meet. Know what 

portion of your premium and costs you will pay, 

how much they will be, and who to talk to if you 

have questions. 
Another option to consider is enrolling in coverage 

through the Health Insurance Marketplace 

(Marketplace). The Marketplace offers health 

insurance plans that provide comprehensive 

health coverage that present their price and 

benefit information in an SBC so you can make 

comparisons. Keep in mind that with most jobbased health insurance plans, your employer pays 

part of your premiums. If you pick a Marketplace 

plan instead, the employer usually doesn’t 

contribute to your premiums. 

Job Loss 

What if your health care coverage ends 

because you lose your job, have your hours reduced, 

or get laid off ? Knowing your rights ahead of time can 

prevent these situations from meaning an end to health 

care coverage. Under the Health Insurance Portability 

and Accountability Act (HIPAA), you may be eligible 

to enroll in your spouse’s health plan without waiting 

for an open enrollment period. Under the Patient 

Protection and Affordable Care Act (ACA), you can 

buy individual insurance coverage through the Health 

Insurance Marketplace. For other employment-based 

coverage (such as a spouse’s plan), you must request 

enrollment within 30 days of your loss of coverage. 

For Marketplace coverage, you must select a plan 

either within 60 days before losing coverage or within 

60 days after losing coverage. You, your spouse, and 

your dependent children also might be able to purchase 

extended health coverage for up to 18 months under 

the Consolidated Omnibus Budget Reconciliation Act 

(COBRA). You may have to pay the entire premium 

plus a 2 percent administrative fee. Also, contact your 

state government to find out if you or your dependents 

are eligible for public health insurance, like Medicaid 

or the state Children’s Health Insurance Program. 

Get information and compare your options before 

you decide which coverage to elect.
Looking for a New Job?

Before switching jobs, ask about the type 

of health plan offered by the potential employer 

and compare it to your current plan. Ask about the 

premium you’ll pay under the new plan, what it covers, 

whether you can continue with the same doctors, or 

whether you will have to see new ones. Check to see 

if your potential employer’s plan has a waiting period 

before you can enroll in coverage – generally, it may 

last up to 90 days from the date you become eligible 

for the plan. COBRA may give you the opportunity 

to purchase temporary extended health care benefits 

offered by your former employer while you are looking 

for a new job or during a waiting period for health 

benefits imposed by your new employer. 

Retirement

When you’re thinking about retiring,

be sure you understand the documents governing 

your health care plan. Review your SPD and any 

documents you have received that modify it. Also, 

request copies of any formal written documents 

that outline how your plan operates, and any other 

information on your employer’s policies on retiree 

health care benefits. Realize that although some 

employers continue to provide health care benefits to 

their retired employees, private-sector employers are 

not required to provide retiree health benefits. And 

remember, Federal law does not prevent employers 

from cutting or reducing health benefits under plans 

available to participants and their families, unless 

there has been a specific promise to continue them 

and that promise can be legally enforced. 

If you want to retire early, consider what you will 

do for health coverage before you are eligible for 

Medicare. Your options may include enrolling in a 

spouse’s employer plan or in a Marketplace plan or 

temporarily continuing your employer coverage by 

electing COBRA. Your rights to these options will 

depend on your individual circumstances, so find out 

what your options are before you retire. 
At a Glance

HIPAA

HIPAA allows you and your family members to 

special enroll in your employer-sponsored health 

plan or your spouse’s when you lose other coverage 

or experience certain life events such as marriage, 

birth, adoption or placement for adoption. 

HIPAA also protects you against discrimination 

in health coverage based on certain health factors 

such as prior medical conditions, previous claims 

experience, and genetic information. 

ACA

The ACA protections related to employment-based 

group health plans include extending dependent 

coverage until age 26, prohibiting preexisting 

condition exclusions, banning annual and lifetime 

limits on coverage for essential health benefits, 

and requiring group health plans and insurers 

to provide an easy-to-understand summary of 

a health plan’s benefits and coverage. The ACA 

also allows you to enroll in health coverage through 

the Health Insurance Marketplace. If you enroll 

in Marketplace coverage, you may be eligible for 

a tax credit that will lower your monthly premiums 

and cost-sharing reductions that will lower your 

out-of-pocket costs for deductibles, coinsurance 

and copayments. 

COBRA

If you are covered under your employer’s health 

plan and you lose your job, have your hours 

reduced, or get laid off, and your employer’s health 

plan continues to exist, you and your dependents 

may qualify to purchase temporary extended health 

coverage at group rates under COBRA. Divorce, 

legal separation, loss of dependent child status, 

the covered employee’s death, or entitlement to 

Medicare may also give your covered spouse and 

dependent children the right to elect continued 

coverage under COBRA. Your plan must be 

notified of these events. Generally, COBRA covers 

group health plans maintained by employers with 
20 or more employees. The group health plan 

is required to provide you with a written notice 

indicating your eligibility for COBRA coverage. If 

you are eligible, you will have 60 days from the date 

the notice is sent or from the date your coverage 

ends — whichever is later — to elect COBRA. If 

the employer is too small to be subject to COBRA, 

state law may require the plan’s insurer to provide 

some continuation coverage.

For More Information:

The Department of Labor’s Employee Benefits Security 

Administration (EBSA) administers several important 

health benefit laws covering employer-provided health 

plans and your basic rights to information on how your 

health plan works, how you qualify for benefits, and how 

to make claims for benefits. In addition, there are specific 

laws protecting your right to health benefits when you 

lose coverage or change jobs. 

Visit the Employee Benefits Security Administration’s 

Website at dol.gov/ebsa to view the following 

publications. To order copies or to request assistance 

from a benefits advisor, contact EBSA electronically at 

askebsa.dol.gov or call toll free 1-866-444-3272.

• Retirement and Health Care Coverage...Questions 

 and Answers for Dislocated Workers

• An Employee’s Guide to Health Benefits Under COBRA

• Your Health Plan and You — Know Your Health 

 Coverage Protections

• Can the Retiree Health Benefits Provided by Your 

 Employer Be Cut?

• Top 10 Ways to Make Your Health Benefits Work for You

• Life Changes Require Health Choices...Know Your

 Benefit Options

• Taking the Mystery Out of Retirement Planning

You also may visit the U.S. Department of Health and 

Human Services Website at HealthCare.gov or call 

1-800-318-2596 to find out more about Marketplace 

plans. Or contact your state insurance commissioner’s 

office.

December 2014

EMPLOYEE BENEFITS SECURITY ADMINISTRATION

UNITED STATES DEPARTMENT OF LABOR