If there is a lawsuit, the plan administrator could go before an IRS agent in a health plan audit or federal judge in a civil case. Ultimatley the employer is responsible for actions of it's agents, including whomever is managing the group health plan. To avoid litigation, your plan administrator should have:
Extended COBRA coverage to your within the legal time frame
Sent each of your dependents and spouse an initial COBRA notification to the last known address within 90 days of being first enrolled in the group health plan
Sent the notices certified first-class which proves when and who the notices were mailed to.
Provides the employee with an election notice in connection with a qualifying event within 14 days from that event to your last known address
Notified you of the COBRA disability extension provision
Secured affirmative consent from participants and dependents to recive notices
electroniclly
Informed you which events triggered your right to COBRA continuation coverage
Notified you of all HIPAA entitlements
Compare COBRA Health Alternatives in the green box near the top.
Sent you a certificate of prior creditable coverage
Written procedures that set out precisely which method is being used to provide COBRA notices.
Billed the correct administration fee of between 102% - 200% your premium
Lawfully terminated COBRA coverage when permitted
Notified qualified beneficiaries of conversion options during the required time frame
Kept detailed records of all COBRA-related events
Kept copies of all notices sent to you, including type of delivery
Kept accurate records of premiums you sent them
Been notified when an employee becomes eligible for Medicare or commences a Chapter 11 bankruptcy within 30 days.
If your cobra plan administrator is not following the above, employees and their dependents may not be getting their entitlements. The employer can quickly become responsible to the IRS and DOL for ERISA penalties, as well as civil lawsuits for uncovered medical expenses.
If your plan administrator is not doing the above, there are plenty fine companies out there, find a company that does provide timely up to date TPA services.
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.
