COBRA Health plan Advice for Individuals and Small Businesses
 



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COBRA FAQ

Why did the government create COBRA?
Before COBRA in 1999, when an employee left their employer or company, they ended all their health insurance. If the employee or a family member had a pre existing condition, they could not get private health insurance. So the employee or qualified dependent stayed insured and off government programs.

What should the COBRA notice contain?
The COBRA notice should have the benefits that may be available to the covered employee and future dependents. It should include the exact premium required and die dates. It should detail the covered employee and dependents notification obligations to the plan administrator regarding divorces. And how dependents cease to be dependents under the terms of the plan. The qualifying event notice should include the actual last date to elect COBRA.

What qualifies me for COBRA?
Loss of health insurance due to an employee's death, termination, reduced hours of employment or entitlement to Medicare. Also divorce or legal separation or a child's ceasing to be covered as a dependent under plan rules.

Can they regular mail me COBRA notice?
The plan administrator is obligated to document or record that they 1st class mailed the COBRA notice, not if it's been received. Both the U.S. DOL and Courts have ruled regular mail sufficient for COBRA notices.

How long do I have to elect COBRA coverage?
You must be given a defined election period during which each qualified beneficiary may choose whether to elect COBRA coverage. Qualified beneficiaries must be given at least 60 days for the election.

Can my wife elect COBRA without me?
Each qualified beneficiary may independently elect COBRA coverage. A covered employee or the covered employee's spouse may elect COBRA coverage on behalf of all other qualified beneficiaries.

I was on COBRA then became disabled. Can I extend my coverage?
If you are ruled disabled by the Social Security Administration within the first 60 days of continuation coverage, you would qualify for 11 more months of COBRA.

I unenrolled from the COBRA plan Should I get a Certificate of Portability?
Under HIPAA, any loss of insurance means a Certificate of Portability must be sent to the individual losing coverage.

Can I get my kids covered by COBRA?
A parent or legal guardian may elect on behalf of a minor child.

Can the company end my COBRA coverage early?
Yes, if premiums are not paid in full, the employer ends the group health plan, you begins coverage under another group health plan, you become entitled to Medicare benefits or engage in fraud.

My COBRA was canceled and the company says it's the COBRA administrator's problem.
Since the COBRA administrator was acting on behalf of the former employer, the company is always responsible for all COBRA or HIPAA mistakes by it's agents.

I took a leave of absence under the FMLA. Can I get COBRA?
If you don't return to work after the FMLA period expires, you should be offered COBRA. The 18 months of COBRA coverage begins then. COBRA coverage is never back dated.

My new employer's group health plan does not cover pre existing conditions. Can I get COBRA?
If the COBRA participant has a health condition not covered under the new employer's plan, the qualified beneficiary can maintain the COBRA coverage so the pre-existing condition is covered.

I have not heard anything from my plan administrator!
Basically your notice must be provided in person or by first class mail via the plan administrator within 45 days after the qualifying event (loss of health insurance) has occurred. The employer must notify the plan administrator within 30 days. The plan administrator must notify you within 15 days of being notified by your employer.

Can they raise my COBRA premiums?
As long as the company increases the premium for everyone, they can raise the rates. Remember, they aren't just offering it for COBRA participants, but are raising it on the group health plan, and so everyone is paying more.

What if my COBRA provider goes out of business?
Yes. Because whatever happens to the regular employees, happens to you also, since it is continuation coverage. Read about employer bankruptcy and COBRA.

No one from my company is contacting me
First contact your health plan administrator or HR department through your employer, whoever was in charge of the company health plan. If the benefits plan is self administered, your employer must contact you regarding your entitlement.

Can the administrator count Saturdays and Sundays towards the election period?
They can unless the last day of the election period ends on a Saturday, Sunday, or a federal holiday, then they are required to extend the election period until the end of the following business day.

My company has told me they are not going to offer me COBRA.
Find out if you are eligible for COBRA. If you are, send the health plan administrator a demand letter requesting your COBRA entitlement. Also you can contact your government investigator. If the case has merit, they will appoint an investigator, start a case, to see if there is a pattern of abuse. Although your investigator cannot impose fines to the company, you have the option of suing the employer in federal court. If the judge finds they broke the law, they can be fined up to $110 per day, payable to you, till they give you the notice.

What is the grace period to pay COBRA payments?
A qualified beneficiary has 30 days grace period to pay premiums, from the first day of the monthly benefit period. The employer or plan may offer a grace period longer than 30 days.

Are the benefits different from my old plan?
No. Qualified beneficiaries must be offered benefits identical to those received immediately before qualifying for continuation coverage.

How soon do I have to pay?
The first payment must be made within 45 days after the date of the COBRA election.

I elected COBRA, but then got married. Can I add my new wife?
Check the health plan rules. If they allow an active employee to add a new spouse, then the qualified beneficiary also has this right. The new spouse does not gain the rights of a “qualified beneficiary” and can only stay enrolled for as long as the COBRA participant is covered.

My administrator is not sending me monthly bills
There is no COBRA requirement to bill monthly, send coupon books, warning letters, lapse notices, or other courtesy notices. You must receive a termination of COBRA notice and updated Certificate of Health Insurance Portability.

I worked for my employer one day. Can I get COBRA?
It depends if you were covered by the health plan even 1 day. If so, you probably qualify for some form of COBRA (Either federal or mini). But most employers have a waiting period of at least 30 days before health insurance benefits start.

How soon do I have to enroll?
60 days from the date that the notice was sent to you.

Do I get to choose between the several group health insurance plans during the annual open enrollment period?
COBRA participants are entitled to the same health insurance plan options and open enrollment rights that all the active employees have.

Do I have to get a notice, if my COBRA coverage is canceled for non-payment of premium?
Yes, you must get a termination of COBRA notice and an updated Certificate of Health Insurance Portability.

Can I take longer than 60 days to elect COBRA?
COBRA statute a "minimum" COBRA election period of 60 days. It is up to the employer to establish the maximum time limit. Most employers want the minimum 60 day election period to also be the maximum. Check if your COBRA notice states the election period is a maximum 60 day period of time

Does my COBRA plan have to cover dental and vision?
If those benefits were part of the original plan. If they are optional or "none core," you don't have to elect to get them.

Can Can I send the COBRA election form back the last day of the election period?
If the COBRA election form is postmarked within the election period, you have elected.

My employer gave me the COBRA notice at my exit interview
Sometimes employers will have the employee sign a receipt they got the notice. Also hand delivery to the employee is not notification to any other qualified beneficiary's. If you have a spouse or dependents, You would need to get regular mailed a COBRA qualifying event notice.

My COBRA benefits are expiring soon!
Consider buying converting to a new plan under HIPAA, or getting private health insurance. If you get hired, there is a good chance your new employer will offer group health insurance.

Why is COBRA so expensive?
Because the insurers have to cover everyone meeting legal requirements, regardless of health. And they subsidized a large portion of the premium, and got to deduct the amount.

Do I have to be offered an individual conversion policy?
Probably, since most health insurance plans, like HMOs, PPOs, etc. have individual conversions. But most partially self-funded plans do not offer conversion.

My legally separated spouse ended my coverage through her plan. Can I elect COBRA?
If you notify the plan administrator within 60 days of your divorce or separation.

My HR department told me I was late in electing COBRA!
The election period must not end before the date that is 60 days after the date notice is provided to the qualified beneficiary of her or his right to elect COBRA continuation coverage. You can view the applicable federal regulations regarding electing COBRA coverage

Do I really owe taxes on my COBRA plan subsidy for 2010?
Yes, if your income was over certain limits, if you're single making over $145,000 or married making over $290,000.

Can my a domestic partner get benefits under COBRA?
There is no federal requirement to offer continuation of benefits to a domestic partner when coverage ends. The benefits provider does not have to extend coverage that is not required by COBRA. Employers may choose to offer the option of continuing domestic partner benefits. You could find employment at one of the many private companies that now extend benefits to domestic partners.

Are COBRA benefits different from active employees?
The coverage must be identical. Any changes to the health insurance plan must apply to both former and active employees.

Can I waive COBRA coverage for my husband?
As a qualified beneficiary, your husband has his own independent election rights.

My old employer self administers COBRA. How soon must they send the COBRA notice?
An in house health plan administrator has 14 calendar days to provide the notice from the date they learned the qualifying event occurred.

Who regulates COBRA health insurance laws?
Public-sector health insurance plans are overseen by the US Department of Health and Human Services. The US Department of Labor (DOL) and US Department of Treasury (IRS) have authority over Private-sector COBRA coverage.

What type of plans are not covered under COBRA?
Your employer is not required to offer continuation coverage for life or disability insurance, retirement or vacation plans.

What Happens to my Flexible Spending Account (FSA) under COBRA?
The administration of flexible spending accounts is also continued under COBRA.

Can I elect COBRA if my new employer plan does not cover pre existing conditions?
You can reduce or eliminate the maximum preexisting condition period if you can show "creditable coverage."

I refused to elect COBRA at my former employer, can I still enroll?
COBRA has a 60 day period from the date you were mailed the COBRA notice. If the 60 day time limit has not expired, inform your employer you want to continue COBRA coverage.

Do I have to enroll in the dental and vision plans under COBRA which I had in the company plan?
You may choose different types of coverage under COBRA, some, or none of the plans. One exception would be if the plans were bundled or packaged together.

Am I eligible for the annual open enrollment?
If you are a COBRA eligible participant, you have the same enrollment rights as all active employees.

When I send in my COBRA election form, should I include the 1st month's premium?
You have 45 days from the date of election to make your first premium payment. However, your insurance carrier may not pay claims until full payment has been received through the current month. That means that you probably will have to pay 3 months of full COBRA premium plus the 2% management fee, which can be substantial.

Can I elect COBRA if I have other group health insurance?
If you had other group coverage before electing COBRA, you might be able to continue both coverages under a couple circumstances: Your new coverage has a waiting period for a pre-existing conditions or is substantially limited.

What happens to COBRA if I become eligible for Medicare?
Your COBRA insurance may terminate when you become entitled to Medicare.

If I become Medicare eligible during COBRA, can my dependents continue coverage?
If your dependents are qualified beneficiaries their COBRA coverage may continue but not be extended.

Written by Craig J. Casey

Craig Casey is an Writer, Coach, Blogger, Husband, and Former Health Insurance Agent helping people on the web since 1999 with their health insurance problems.
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