"JOB LOCK" got you down? Job lock is when you want to change jobs, but can't, because you would lose your health insurance coverage.

Job lock is a fact of life for many people. But two laws, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA), help some people under some circumstances.

COBRA

COBRA allows some people who would otherwise lose group health insurance benefits to continue them for a limited time.

COBRA applies to people who are covered by a group health plan provided by an organization that employs 20 or more people. (An exception: federal government employees.) A person can continue health coverage temporarily if he or she has lost health insurance because

* The covered employee quit or was terminated for a reason other than gross misconduct.

* The employee now works fewer hours.

* The employee became entitled to Medicare.

* The covered employee divorced or separated from his or her spouse.

* A child becomes too old to be covered as a dependent anymore.

* The covered employee dies.

Coverage generally continues for 18 months to 36 months, depending on the circumstances that caused you to lose insurance. However, coverage can end early under certain circumstances--for example, if you don't pay premiums on time or you get other employee group health insurance that covers your preexisting conditions.

In order to receive COBRA benefits, you must notify your company's plan administrator of relevant personal changes, such as a divorce, within a certain number of days. Your company must notify the plan administrator of events such as your leaving the company or reducing your hours. Once your company administrator sends you a notice that you are eligible for COBRA, you must sign up within 60 days if you want COBRA coverage. All eligible family members may sign up, but it's okay if some do and some don't.

Many people are unable to use COBRA because of the high cost. When you were an employee, your company probably paid most of your group health insurance premium. When you continue your insurance through COBRA, you may be required to pay 102 percent of the total premium--which includes both what you were paying and the larger share your company was paying.

Your company's plan administrator can explain COBRA in more detail to you.

HIPAA

HIPAA allows certain people who are signing up for a new health insurance plan to be covered for preexisting conditions (health problems they already have) without a waiting period.

HIPAA covers people who have had continuous health insurance coverage without a break of 63 days or more. (Some states under certain circumstances extend this 63-day limit.) This insurance does not have to have been at a job. It could have been individual insurance, COBRA coverage, Medicare, Medicaid, or Indian Health Service, for example. However, HIPAA may not apply to certain group plans.

HIPAA covers people who

* Are changing from one group plan to another

* Are changing from a group plan to an individual plan

* Are changing from an individual plan to a group plan

HIPAA prohibits some kinds of discrimination. Employers cannot exclude people from coverage or charge them more than usual just because of a health problem, a disability, or information discovered during genetic testing. Preexisting condition clauses cannot be applied to pregnancy.

HIPAA also limits what insurers can consider a preexisting condition and how long they can exclude coverage for it. An insurer can exclude a condition only if you were diagnosed with it, received advice about it, or received or were recommended to receive care or treatment for it within six months of your enrollment in the new group plan. The exclusion can last no longer than 12 months (18 months for late enrollees).

You can reduce the waiting period for preexisting conditions in the new plan by the length of time you were continuously covered before. If you had had continuous health insurance for 12 months, then a 12-month waiting period will be waived.

HIPAA does not require employers to offer health insurance or set caps on how much insurers can charge. Nor does it require that your new plan be as good or as cheap as your old one.

Other Sources

COBRA and HIPAA are imperfect safety nets. Some people, however, can't get COBRA benefits because

* They had an individual health policy.

* Their employer had less than 20 workers.

* Their employer didn't have a health plan or dropped it.

* Their company closed or went bankrupt and no longer has a health plan.

* They can't afford to pay a large premium while unemployed.

People also may not be able to use HIPAA benefits for several reasons:

* They're changing from one individual health plan to another.

* They didn't have health insurance before getting their new job.

* They didn't sign up for COBRA, and they didn't find a new job and get coverage within 63 days.

* Their new job doesn't offer health insurance.

If you fall through the gaps, don't despair. You may be able to get health insurance some other way. You should first call your state insurance commission for advice. In addition,

* Some states' laws are more generous than the federal government's. For example, some states require waiting periods for preexisting conditions to be less than 12 months or allow you to continue coverage even if your company has fewer than 20 employees.

* Some states have a high-risk insurance pool.

There are other options as well:

* You may be able to get an individual health insurance policy. (These, however, are usually even more expensive than COBRA coverage.) Your previous group policy may allow you to convert to an individual policy. Also, HIPAA guarantees that certain people who've had at least 18 months of continuous coverage can get individual coverage (although it doesn't guarantee that it will be affordable).

* You may be able to enroll in your spouse's group health insurance plan.

* You may be eligible for group insurance offered by your college alumni organization or a professional organization you belong to.

Shauna S. Roberts, PhD, is a science writer from New Orleans, La.

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