Steve talks about Cal – COBRA

Employee's guide to COBRA - Department of Labor
Employee’s guide to COBRA – Department of Labor

Federal COBRA and California Cal-COBRA   basically provide that if you are no longer covered under your Employer’s group health plan, you can keep the coverage regardless of your health and with no pre-existing condition clause for 18 (Federal) or 36 months (California) at 2 to 10% more premium than your employer was being billed from the Insurance Company.

Since everything now is Guaranteed Issue with No Pre-X under Health Care Reform, consider going on an Individual Plan.

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Even if it’s NOT Open Enrollment, there is Special Enrollment, as you have just lost coverage MEC.  Under Special Enrollment, your coverage is the first of the month after you apply, rather than the crazy 15th and miss a month deadlineEmails dated 1.21.2015 2:07 PM

If you have problems obtaining your COBRA,  or CAL COBRA coverage, we can lead you in the right direction.  It’s basically though something that you arrange directly through your Former Employer’s HR Department or Insurance Company. We suggest that you get Quotes for the Healthy Members of your Family and see if you can get a better alternative than COBRA.  With your own Individual coverage you have the option of taking a higher deductible, HSA or not taking maternity dental, life or vision to save $$$.

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FAQ’s

Ask New Questions?

Since COBRA has been made pretty much obsolete under Health Care Reform… not all the links work… Try scrolling the entire page or just   Email us.

1. Does the Department of Labor have a FAQ Section or FAQ’?

2.  Where can I get more details on MY specific plan and options?

KQED story about a reporter taking five weeks to get coverage with Covered CA.   Part of the problem was answering the question about if you have COBRA coverage.  We can help you with this, no extra charge.  First, get a instant  quote and we will contact you.

3.  What happens if your Employer changes coverage from one Insurance Company to another?

4.  What if my COBRA gets cancelled?

5.  What if I’m separated and my spouse cancels my coverage, is that a Qualifying event?

6.  Where can I get more information on Cal COBRA?

Find your Evidence of Coverage, SAMPLE,  and you can get TONS of detail on HIPAA, COBRA & Cal COBRA

Blue Cross Small Group Plan SAMPLE EOC

Kaiser COBRA Specialist # 866-429-0142

7.  How much notice must one receive, before COBRA rates can go up?

8.  Do you have an FAQ section for Cal COBRA? What is Gross Misconduct?

9.   What notices must the Employer give the Employee?

Lapse?  Re-Instatement?  Grace Period? COBRA

There is a minimum 30-day grace period for each successive payment due date. Payment is considered made on the date it is postmarked (if it is mailed), not the date of the check or the date the payment is physically received by the Plan. (cms.gov Page 15 Section V # 4,  dol.gov, vantaggiohr.com Treasury Regulation   §54.4980b-8 Question # 5)

Under the new regulations, qualified beneficiaries must receive what is called an “Early Termination Notice” if they lose coverage due to failure to make payment by the due date or within the grace period. (dol.gov/)

Notification of COBRA Rights

When there occurs a “qualifying event” that entitles persons covered by an employer group health plan to elect continuation coverage, such as the employee’s termination of employment or death, the divorce of the employee and his or her spouse, or a dependent child’s ceasing to qualify for dependent coverage under the plan, a notice of the right to elect continuation coverage generally must be sent to each person (termed in the COBRA law a “qualified beneficiary”) who has that right. If the “qualifying event” is the employee’s termination, reduction of hours or death, the employer has 30 days after the event (or, if later, 30 days after the date coverage is lost) to notify the plan administrator, which in turn must give the notice of COBRA rights within 14 days to persons entitled to elect coverage. (If the employer and the plan administrator are the same, it has the full 44 days to give the notice.)

How soon the notice is provided affects how long eligible persons have to elect continuation coverage because they must be given at least 60 days from the date of the notice. Wilcox & Savage Esq.  *   Reporting & Disclosure Guide (DOL)

COBRA Detailed Definition

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances “Qualifying Event” such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan. (110% for Cal Cobra)

COBRA generally requires that group health plans sponsored by employers with 20 or more employees in the prior year (2 with Cal Cobra) offer employees and their families the opportunity for a temporary extension of health coverage (called continuation coverage) in certain instances where coverage under the plan would otherwise end.

COBRA outlines how employees and family members may elect continuation coverage. It also requires employers and plans to provide notice. (Department of Labor )

When your employer changes Insurance Companies, the COBRA coverage goes with the NEW company. (DOL Guide Page 11 “Similarly Situated Active Employees, Code of Federal Regulations § 54.4980B-5Q 1 & 4)

 

Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) – COBRA

is a federal law that provides rights to temporary continuation of group health plan coverage for certain employees, retirees and family members at group rates when coverage is lost due to certain Qualifying events (§ 1163). Generally, COBRA applies to employers who employed 20 or more employees in the prior calendar year. If the group health plan is a multi-employer, collectively bargained plan, only one contributing employer needs to have 20 or more employees in the prior year in order for COBRA to apply to the whole plan.

Fact Sheet DOL

COBRA Study

Draper v Hughes

Required Notice for COBRA rates to go up?

The applicable premium must be fixed for a 12-month “determination period.” ERISA § 604 (3); Treas. Reg. § 54.4980B-8, Q/A-2(a) §1164 (3). Therefore, a mid-period increase in insurance rates will not permit a mid-period increase in the COBRA premium charged to QBs. Heart of Matters.com benefitslink.com/

The law limits the conditions when the applicable premium may be increased during a determination period.

A determination period is any 12-month period selected by the plan that is applied consistently from year to year. During a determination period, a plan can increase the premium only in the following three cases:

  • (1) The plan has previously charged less than the maximum amount permitted and the increased amount required to be paid does not exceed the maximum amount permitted; or
  • (2) The increase occurs during a disability extension and the increased amount required to be paid does not exceed the maximum amount permitted; or
  • (3) A qualified beneficiary changes the coverage being received. Because the law is clear in its guidance for premium increases, it is advisable to consult your benefits professional or legal counsel when passing on rate increases to COBRA participants for reasons not stated above. (cobrapoint.com)

Legal Separation?  Unofficial Separation?

Q-1: What is a qualifying event?

A-1: (a) A qualifying event is an event that satisfies paragraphs (b)…

(b) An event satisfies this paragraph (b) if the event is any of the following—

(3) The divorce or legal separation of a covered employee from the employee’s spouse;

(c) An event satisfies this paragraph (c) if, under the terms of the group health plan, the event causes the covered employee, or the spouse or a dependent child of the covered employee, to lose coverage under the plan. For this purpose, to lose coverage means to cease to be covered under the same terms and conditions as in effect immediately before the qualifying event. … If coverage is reduced or eliminated in anticipation of an event (for example,… an employee’s eliminating the coverage of the employee’s spouse in anticipation of a divorce or legal separation), the reduction or elimination is disregarded in determining whether the event causes a loss of coverage. 26 CFR 54.4980B-4 Qualifying Events

Gross Misconduct?  Might prevent you from getting COBRA

Call us to discuss 310.519.1335.    We will open up Tax Facts with details we can’t post due to copyright.

Open Enrollment NAIC

 

Know your COBRA rights
 
This short presentation will walk you through a scenario that will help address some questions that may come up when you’re counseling consumers who lose their job-based coverage

 

Employee, Dependent & CONSUMER Resources & Links

 Employee’s Guide to Federal COBRA

Disability Benefits 101.org

Sample Notice of COBRA rights

Cobra Information

Employer, Technical & Research Links

Employer Reporting & Disclosure Guide (DOL)  aka Health And Retirement Benefits After Job Loss

COBRA Final Regulations 5/26/2004

 

3rd Party Administrators & Reference Services

Ceridian COBRA Compliance Services

Employee Benefits Institute of America

COBRA Federal Regulations

If links do not go directly to what you are looking for… try “search” on the Government Site or “Google.”

§54.4980B-0   Table of contents.
§54.4980B-1   COBRA in general.
§54.4980B-2   Plans that must comply.
§54.4980B-3   Qualified beneficiaries.
§54.4980B-4   Qualifying events.
§54.4980B-5   COBRA continuation coverage.
§54.4980B-6   Electing COBRA continuation coverage.
§54.4980B-7   Duration of COBRA continuation coverage.
§54.4980B-8   Paying for COBRA continuation coverage.
§54.4980B-9   Business reorganizations and employer withdrawals from multiemployer plans.
§54.4980B-10   Interaction of FMLA and COBRA.
§54.4980D-1   Requirement of return and time for filing of the excise tax under section 4980D.
§54.4980E-1   Requirement of return and time for filing of the excise tax under section 4980E.
§54.4980F-1   Notice requirements for certain pension plan amendments significantly reducing the rate of future benefit accrual.

ERISA & US Code Links

Tax Facts Requires Subscription Email us to discuss

COBRA Continuation Coverage Requirements

 

Historical

Our Pre Underwriting form will save you time and effort to see if you qualify for a Individual & Family Plan.When your COBRA or CAL COBRA coverage ends, expires, terminates… you pre health care reform could have  HIPAA guaranteed issue, until you reach Medicare eligibility.  Now it’s Obamacare

 

 

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2 comments on “COBRA – Right to Keep your Employer Group Health Coverage

  1. 1 When does the employer have to give notice of my right to purchase COBRA coverage?

    2 Is there a penalty if the employer does not give timely notice?

    3 Do I have any recourse if the employer did not notify me of my right to purchase COBRA and I purchased a more expensive Obama – ACA plan?

    • 1 Within 44 days after you lose coverage. Click here or scroll back up to see detail.

      See page 5 of Employers Guide to COBRA for more details on notices, including letting you know when you first get covered under the Employer Plan that COBRA rights are included when you lose coverage.

      2 Penalties are on these other websites SHRM.com * Bizfluent.com * Queens Employment Attorney.com *

      3 You might contact Blue Shield either by phone or your member portal show them that you have other coverage and they might go ahead, cancel and refund your $$$. I don’t have anything in writing that the Individual Plan carrier will do this, but have been told they will.

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