The federal American Recovery and Reinvestment Act of 2009 (ARRA) was recently amended to extend both the eligibility period and the duration of the ARRA premium subsidy benefit. The eligibility period was extended for an additional two months to include individuals whose employment is involuntarily terminated through February 28, 2010. The duration of the premium subsidy has been extended an additional 6 months, from 9 to 15 months.
In addition, individuals who already have exhausted the previous 9-month premium subsidy benefit and who chose not to continue group coverage starting December 1, because they would have had to pay the full premium, must be allowed additional time to pay the reduced premium and continue the group coverage. Payment must be made within 60 days of the enactment of the federal amendment or, if later, 30 days after an individual receives notice of the extension. The federal amendment requires that a notice describing the new subsidy provisions be provided to all assistance-eligible individuals who have been on COBRA continuation coverage on or after November 1, 2009, or whose qualifying event is an involuntary termination of employment occurring on or after November 1, 2009.
The purpose of this bulletin is to inform insurers that the Office of the Commissioner of Insurance expects insurers to comply with these new ARRA premium subsidy provisions for group health plans with less than 20 employees that are not subject to federal COBRA, but are required to comply with the Wisconsin continuation and conversion law, s. 632.897, Wis. Stat. The office has issued an emergency rule that incorporates the new federal requirements and applies them to individuals eligible under state continuation law.
Insurers should assist employers by providing an appropriate notice concerning the additional time that is allowed individuals who have exhausted 9 months of the premium subsidy to pay the premium necessary to continue coverage. Insurers should also amend the sample ARRA notices previously included in an earlier bulletin from this office to comply with the new premium subsidy provisions. Insurers are reminded that they are required to provide such notices if the employer fails to do so.
If you have questions concerning this bulletin, please contact Mike Honeck, Chief of the Health & Life Section, at mike.honeck@wisconsin.gov.