Since I am not able to sign up for COBRA for 30-60 days, what happens if I need to visit the doctor or emergency room before COBRA coverage begins? Is COBRA retroactive?
The answer is that COBRA is retroactive to the day you lost coverage. But you must send in your paperwork within the 60 day election period (defined below) and also pay within the 45 day window (also below).
If you need a procedure or to see a doctor, you can always ask the if the medical provider can bill directly. Do not forget to request the negotiated rates, since the bill will hopefully be paid by your insurer after you return your paperwork and premium. I have some other ideas I brainstormed in How to Cut Your Health Care Expenses.
Another strategy would be to request 60-90 days to pay, then forward the bills to the insurance company. It will all depend if you need a procedure or if it's a non emergency.
If you are pregnant and not yet on COBRA, I feel your pain! We had our baby about 10 months ago. Talk about stress! Anyway, I hope you did some timing / planning, because without coverage, a pregnancy can significatnly add to the cost of a new baby.
60 Days to enroll in COBRA
Every qualified beneficiary has an election period of 60 days to enroll in COBRA. The 60 day window usually begins the day of mailing of the COBRA notice or
the day your coverage was terminated.
Since we've never heard of an employer mailing out a COBRA notice before your coverage was terminated, 99.9999% of the time, the date of mailing will start your 60 election period. Please note that even if you pay, without your written consent, the plan administrator will not extend COBRA to you, so send in your paperwork! I hate it too.
45 Days to Pay Back Premiums
The health administrator wants to collect premium payments within 45 days from the day you elect COBRA. They will require all back COBRA payments, since your coverage is retroactive to the day of loss. The extra time to elect and pay is great, but you will most likely freak out when you get a monster bill.
Example: You wait the full 60 days to elect COBRA, then you wait another 45 days to make payment, over 3 months! Equaling 105 days. The administrator can and will require you to pay 3 months of COBRA premiums. For some especially enrolling several people or even a family that can means $2000, $3000 even $5,000+. Ouchie!
But wait, if you are undecided on needing COBRA, these maximums can be great. No other form of insurance that I know of (besides the government run programs) have this type of "look back" provision. Maybe that's why all the government run welfare programs are bankrupt? The laws allows you to maintain your COBRA rights for up to 105 days without paying so you can retroactively get medical insurance, depending on if you have an emergency or need medical services.
If you decide to send in the COBRA paperwork within the 60 days, but do not pay the premiums within the 45 day window, your health coverage would not be retroactive back to the date of your loss of insurance. With medical bankruptcies accounting for over 50% of all chapter 7s, get other health insurance, either short term medical or another employer group plan.
If you experience a 63 day or more gap without health insurance coverage, you might be subject to sa new plan's pre-existing condition clause.
30 Day Premium Grace Period
After you send in the COBRA election paperwork and pay, you have 30 day grace period after the due date to pay your monthly premium. Which is exactly the same as most health insurers require from your former employer. Fun fact: If you end up with multiple COBRA payments being due, they will cancel you. So do not abuse the power of the grace period.
If you get your cobra canceled, you can lose your conversion rights and that starts the 63 day clock, which is very important if you have pre existing conditions.
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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