PPO stands for preferred provider organization. A preferred provider organization is an arrangement between a group of doctors or providers and an entity, such as an employer or other group. This arrangement makes it possible for price discounts on services in exchange for a higher volume of patients. A PPO arrangement may be part of a self-funded health care plan. If your coverage is provided under a PPO contract and you do not utilize the preferred providers, you may have substantially higher co-payments.

COBRA is an acronym for the federal Consolidated Omnibus Budget Reconciliation Act of 1986. This federal law allows terminated employees and their families who may lose group health care coverage because of termination of employment, death, divorce, or other life events to continue the group coverage for specified periods of time. The individual employee must pay the premium which can be no more than 102% of the "applicable premium", which is defined as the cost of coverage for similarly situated persons remaining under the group health plan. The law generally applies to group health coverage provided by employers with 20 or more employees, but does not apply to federal employees and church-sponsored plans. More information is available at: http://www.dol.gov/dol/topic/health-plans/cobra.htm.

HIPAA is an acronym for the federal Health Insurance Portability and Accountability Act of 1996. This federal law places limits on exclusions for preexisting conditions, prohibits discrimination against employees and their families based on their health status and guarantees renewability and availability of health coverage to certain employees and their families. Generally, the HIPAA law limits exclusions for preexisting conditions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires that this maximum time period be reduced by the length of time one has had "creditable coverage". A former employer or administrator of your prior health plan should provide you with a certificate documenting your creditable coverage when that coverage ends. More information is available at: http://www.dol.gov/dol/topic/health-plans/portability.htm.

The Michigan Patient Bill of Rights took effect on October 1, 1997 and guarantees your rights to: information about your health coverage plan, health coverage sooner for preexisting conditions that existed before you were enrolled in your current health coverage plan, and faster and more understandable ways of handling complaints. This Michigan law does not apply to self-funded health care plans.

The "birthday rule" is a method used in the "coordination of benefits" provisions of most health care plans to define which plan is the primary payer for an individual who is covered as a dependent under more than one group health care contract. For example, if a child is covered by group health coverage from both parents, the coverage that is primary for the child comes from the parent whose birthday falls first in the year. So coverage provided by the parent whose birthday is January 1 would be primary over coverage provided by the parent whose birthday is April 1.

Michigan law requires that state regulated health benefit contracts use the "birthday rule" in all group health benefit "coordination of benefits" provisions. Self-funded health care plans are exempt from state regulation and therefore, are not required to use the "birthday rule". Some self-funded health care plans use the "gender rule" which provides that the father's plan is always primary when a child is covered by both parents. This type of provision can cause problems if one parent's coverage uses the "birthday rule" and the other uses the "gender rule". If a problem occurs and working with both employers and plan administrators does not resolve the matter, you may contact OFIR toll free at (877) 999-6442 for assistance and advice.