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Laws affecting people with health problems

 

Coping with a serious illness is stressful. It can affect patients and families in many ways. It is important to learn about insurance and employment laws that can help your family as you go through treatment and try to cope with a serious illness.

This page offers a brief summary of some laws that may be helpful to your family. You also can meet with a social worker to discuss how these laws might affect you. These laws are complex. So, this brief summary is not intended as legal advice. It is always best to consult a legal expert in the field.

Laws that relate to St. Jude patients

Family Medical Leave Act of 1993 (FMLA)

FMLA requires employers with 50 or more employees to allow eligible employees to take up to 12 weeks per year off work, without pay but without losing their jobs, for the following family health issues:

  • The birth or adoption of a child,
  • Care of a family member with a serious health problem, or
  • Recovery from the employee’s own serious health problems.

An employee may take FMLA leave in separate blocks of time (“intermittent leave”) because of a single illness or injury. This excused time away from work may range from hours to days or even weeks, such as the time needed for chemotherapy and recovery. When the employee returns from FMLA leave, the employer must place that employee in the same or equivalent job position that she had before the leave began. This law does not reduce any employer-sponsored benefits or collective-bargaining agreement, which might be more generous. The intent of the law is to help employees balance the demands of family and work with as little conflict as possible.

For details on how the Family Medical Leave Act might apply to you, talk with your employer. Your social worker also can help you apply for Family Medical Leave.

Patient Protection and Affordable Care Act (PPACA)

PPACA is widely referred to as the “health care reform law.” It created new rules to protect people from health insurance practices that in the past were used to refuse or cancel health coverage in certain situations. The following are common examples:

Pre-Existing Condition Exclusions: A pre-existing condition is any health problem for which medical advice, diagnosis, care, or treatment was recommended or given within 6 months before the person enrolled in a new health insurance plan. Before PPACA, even if a health condition was normally covered by the insurance plan, an employer could exclude that pre-existing condition for up to 12 months after the person enrolled in the health plan. As of September 23, 2010, PPACA prohibits insurance companies from excluding pre-existing conditions for enrollees younger than 19. After January 1, 2014, insurance companies will not be able to exclude anyone just because they have a pre-existing condition. However, PPACA does not guarantee that any health problems you now have (or have had in the past) are covered by your health plan.

  • Rescissions: A rescission is when an insurance company cancels a person’s insurance coverage for reasons other than the person’s failure to pay premiums.  In the past, some companies canceled a policy and refused to pay medical bills for care that had already been given. Rescissions are now prohibited except in cases where the patient has knowingly lied on the insurance application form.
  • Lifetime and Annual Limits: PPACA prohibits the use of lifetime dollar limits in all health insurance policies issued or renewed after September 23, 2010.  These lifetime limits can cause a person to lose health insurance coverage when medical expenses reach a certain dollar amount. Annual dollar limits on essential health benefits are being phased out slowly and will be prohibited as of January 1, 2014.
  • Coverage for Young Adults: PPACA allows parents to keep their children on their health care insurance plans until they reach the age of 26, as long as those young adults do not have other access to employer-based plans. Even young adults who are living on their own and married can be covered under their parents’ health plans, but their spouses and children cannot be covered.

Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

COBRA is a federal law that permits people who lose health insurance coverage because of certain events to continue that coverage, at their own expense, for a certain number of months. After the following types of events, a person might qualify for COBRA coverage:

  • Death of the employee
  • Divorce or legal separation
  • Loss of dependent status
  • Employee becomes eligible for Medicare
  • Layoff
  • Disability
  • Reduced work hours below the amount required for an employee to take part in the insurance plan
  • Job loss

To continue coverage, the person must pay 100 percent of premium costs plus a 2 percent fee. For help with COBRA, contact your employer or personnel office. Also, if you have questions, speak to your social worker who can help connect you with community resources to answer your questions.

The Genetic Information Nondiscrimination Act of 2008 (GINA)

GINA prohibits health insurers and employers from discriminating (taking wrongful action) against employees based on genetic information. It prohibits health insurers from requesting or requiring genetic information about a person or the person’s family members. It also keeps insurers from using genetic information to make decisions about insurance coverage, rates, or pre-existing conditions.

GINA prohibits most employers from using genetic information for hiring, firing, or any decisions about the terms of employment.

This law does not provide protection for life insurance, disability insurance, or long-term care insurance. Generally, the GINA law does not apply to employers with fewer than 15 employees. If you have questions about how this law might apply to your family, your social worker can help connect you with legal and advocacy resources to discuss these issues.

What can I do if I need more details about how one of these laws might apply to my family?

These helpful hospital and community resources are offered for you and your child:

  • St. Jude social workers
  • The insurance commissioner for your state
  • Consumer advocacy groups

You can find a listing of insurance commissioners by state at the National Association of Insurance Commissioners website: www.naic.org/index.htm.

The Social Work staff at St. Jude can also direct patients and family members to disease specific advocacy groups. If you need to meet with a social worker to discuss legal and advocacy resources, please call your primary social worker or call the social work office at 901-595-3670 to schedule a social work visit.


 

This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.

St. Jude complies with health care-related federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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