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Federal Regulations and Guidelines for Las Vegas based
Employers
a. Federal TEFRA, DEFRA and COBRA
legislation regulates employee health care coverage. Based
on this legislation and the Agreement with the employer, if
a business employs, on average, fewer than 20 employees in a
year and any employee turns 65 years of age, his or her
primary health insurance carrier will be Medicare. For
employees who are at least 65 years old and who choose to
keep their Las Vegas Nevada Group Health Insurance coverage, the group
coverage will be a secondary carrier for Medicare benefits
paid or payable.
b. If a member is covered by Medicare and
Group Health Insurance in Nevada and the group coverage is
secondary to Medicare, the Medicare payment is calculated
first, and the group plan will coordinate up to 100 percent
of coverage for deductibles and coinsurance, not to exceed
the Nevada carriers maximum benefit. Special coordination of
benefits (COB) rules may apply, specifically for Medicare
secondary payer situations. The Nevada group’s certificate
will contain additional details about COB rules.
c. Group health insurance in Nevada is
secondary to Medicare when the following criteria are met:
• The employer has fewer than 20 employees
and the member is at least age 65, or
• The employer has fewer than 20 employees
and the member under age 65 is eligible for Medicare due to
a disability, or
• The member enrolled following the first 30
months of kidney dialysis treatments for end stage renal
disease.
d. COBRA: Participation in the employer’s
benefit plan, as well as coverage under whatever medical
programs are provided by the employer to employees and their
dependents, can be continued under a federal law known as
COBRA for groups that employ 20 or more employees for at
least 50 percent of the previous calendar year. The employer
is responsible for administration within the guidelines
established by the federal government for compliance by
employer groups.
Nevada State Regulations for Las Vegas Based Employers
Nevada State Continuation (NRS 689B 245-249)
provides for continuation of coverage for employees and
their eligible dependents of qualifying groups (i.e., groups
that on at least 50 percent of the working days during the
previous calendar quarter employed 2-19 eligible employees).
Employees must have been continuously covered under the
employer’s plan for 12 consecutive months. Group conversion
is available if the employee was covered for at least three
months. (NRS 689B 245-249)(2)(c). The employer must send written notice of
State Continuation election to employees within 10 days of
termination. Among other things, the notice must include the
amount of monthly premium due.
Within 60 days of the termination date, the
employee must
1) notify the employer in writing of the
employee’s intent to elect State Continuation coverage and
2) remit the appropriate premium amount to
the employer.
An employee and the employee’s eligible
dependents are eligible for State Continuation coverage for
up to 18 months if coverage was terminated due to any of
these qualifying events:
a. The employee dies (continuation for
dependents)
b. The employee’s employment is terminated
or the employee’s hours are reduced, which results in loss
of coverage
c. An enrolled child loses eligible
dependent status
d. The subscriber enrolls in Medicare and
voluntarily cancels his or her coverage with the Nevada
group carrier
e. The employee’s spouse divorces the
employee or legally separates from the employee (eligibility
is extended for up to 36 months)
Most Nevada carriers don’t administer State
Continuation coverage.
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