Pennsylvania's group health questions cover four topics:

• Its mini-COBRA law for small employers (Act 2 of 2009, 40 P.S. 764j).
• Conversion rights when group coverage ends (40 P.S. 756.2).
• The through-age-29 dependent rule.
• Coordination of benefits.

Federal COBRA, HIPAA, ERISA, eligibility rules and the general mechanics of group coverage are in the national Group Health Insurance guide.

Mini-COBRA (40 P.S. 764j, Act 2 of 2009)

Pennsylvania extends continuation rights to employees of employers too small for federal COBRA.

Conversion (40 P.S. 756.2)

• When group health coverage ends, an employee insured under the group for at least 3 months may convert to an individual policy without proving insurability.
• The employee must apply within 31 days after termination.
• The insurer doesn't have to issue a conversion policy to someone who is or could be covered by Medicare.

Dependents and newborns

Dependents through age 29 (Insurance Company Law 617.1, Act 4 of 2009)

• Group insurers must make coverage available, at the employee's expense, for an unmarried child with no dependents who lives in Pennsylvania or is a full-time student and has no other coverage, through age 29.
• This is separate from the ACA's age-26 rule.

Newborns and adopted children

• Newborns are covered from birth. Notice is due within 31 days to continue coverage (40 P.S. 753.1-753.4).
• Adopted children are covered on the same basis as natural children (40 P.S. 775.1).

Group mandates

• Colorectal cancer screening applies to large groups of 51 or more (40 P.S. 764i).
• Serious mental illness benefits (at least 30 inpatient and 60 outpatient days) apply to groups of 50 or more (40 P.S. 764g).
• Alcohol and drug abuse treatment is required in group policies (40 P.S. 908-1 et seq.).
• More mandates are in the Pennsylvania Medical Plans guide.

Coordination of benefits

• When a person is covered by two group plans, coordination of benefits names a primary and a secondary plan so total payments don't exceed 100% of the expense.
• Auto first-party medical benefits pay before group health insurance for auto injuries (75 Pa.C.S. 1719).

Group life (for combined Life, Accident and Health candidates)

Under the Group Life Insurance Policy Law (40 P.S. 532.1 et seq.):

• Grace period: 31 days.
• Conversion after employment ends: any form the insurer customarily issues except term.
• When the group policy itself ends: conversion is available only to people insured at least 5 years.

Common exam traps

• Mini-COBRA: employers with 2-19 employees; 9 months; 3 months of prior coverage; premium up to 105%.
• Conversion: apply within 31 days. Medicare-eligible people can be refused.
• Dependents to 29 is a Pennsylvania option paid by the employee. The ACA rule is age 26.
• Large-group-only mandates: colorectal screening (51+) and serious mental illness (50+).