COBRA Health plan Advice for Individuals and Small Businesses

Re: Shouldn't employer notify you if coverage is ending?

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Posted by Fred on August 10, 2010 at 14:43:24:

In Reply to: Shouldn't employer notify you if coverage is ending? posted by Tracey on June 08, 2010 at 11:17:14:

Tracey

Laws vary depending where you live and State / Federal. ERISA requires the sponsor of a group health care plan subject to its provisions to inform plan participants, including any former employees eligible for plan benefits, of (1) a material reduction in covered services or benefits within 60 days of adopting the change and (2) any other material modification to the plan within 210 days of adoption. Some courts have ruled that canceling a plan is not the same as modifying it and, thus, the ERISA notification rules are not applicable in such a situation. Rather, they held that ERISA rules regarding fiduciary duties are implicated, requiring the plan sponsor to promptly notify plan participants of an impending plan termination.

COBRA requires plan administrators to notify qualified beneficiaries (e. g. , individuals continuing coverage under a group health care plan who would have otherwise lost coverage due to certain specific events) if their coverage will end sooner than the end of the maximum coverage period allowed under federal law. Also, plan administrators must permit qualified beneficiaries to make the same choices given to non-COBRA plan beneficiaries. For example, if an employer replaces its group health care plan with another, then qualified beneficiaries must be offered the same opportunity to elect coverage under the replacement plan.

State law requires an employer providing group health insurance coverage for its employees, when (1) canceling or discontinuing the insurance or (2) substituting it with another insurance policy, to give each insured employee notice of the cancellation, discontinuation, or substitution at least 15 days before the effective date of the change (CGS § 38a-537).

Fred

: I am in New Jersey and we've been covered under my hubby's former employer. I went to a doctor appt. last week and they said I don't have coverage. Hubby called former employer and they said our coverage was up and ended May 1st. They also said there was a mix up of some sort and Horizon BCBS canceled their entire policy & they haven't cashed our checks for the last 2 months. Today I get a letter in the mail from former employer, with our un-cashed checks, saying our coverage ended May 1st. Aren't they supposed to notify us BEFORE the coverage ends? We are in the process of getting covered under hubby's current employer but will we get screwed on pre-existing conditions now that we've gone over 30 days without coverage?

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Subject: Re: Re: Shouldn't employer notify you if coverage is ending?

Comments:
: Tracey : : Laws vary depending where you live and State / Federal. ERISA requires the sponsor of a group health care plan subject to its provisions to inform plan participants, including any former employees eligible for plan benefits, of (1) a material reduction in covered services or benefits within 60 days of adopting the change and (2) any other material modification to the plan within 210 days of adoption. Some courts have ruled that canceling a plan is not the same as modifying it and, thus, the ERISA notification rules are not applicable in such a situation. Rather, they held that ERISA rules regarding fiduciary duties are implicated, requiring the plan sponsor to promptly notify plan participants of an impending plan termination. : : COBRA requires plan administrators to notify qualified beneficiaries (e. g. , individuals continuing coverage under a group health care plan who would have otherwise lost coverage due to certain specific events) if their coverage will end sooner than the end of the maximum coverage period allowed under federal law. Also, plan administrators must permit qualified beneficiaries to make the same choices given to non-COBRA plan beneficiaries. For example, if an employer replaces its group health care plan with another, then qualified beneficiaries must be offered the same opportunity to elect coverage under the replacement plan. : : State law requires an employer providing group health insurance coverage for its employees, when (1) canceling or discontinuing the insurance or (2) substituting it with another insurance policy, to give each insured employee notice of the cancellation, discontinuation, or substitution at least 15 days before the effective date of the change (CGS § 38a-537). : : : Fred : : : : I am in New Jersey and we've been covered under my hubby's former employer. I went to a doctor appt. last week and they said I don't have coverage. Hubby called former employer and they said our coverage was up and ended May 1st. They also said there was a mix up of some sort and Horizon BCBS canceled their entire policy & they haven't cashed our checks for the last 2 months. Today I get a letter in the mail from former employer, with our un-cashed checks, saying our coverage ended May 1st. Aren't they supposed to notify us BEFORE the coverage ends? We are in the process of getting covered under hubby's current employer but will we get screwed on pre-existing conditions now that we've gone over 30 days without coverage? :

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