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COBRA Coordination of Benefits


Guest deacon
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A dependent of an active employee is also covered as a COBRA participant under the dependent's former employer. The dependent is also covered under the spouse's plan. Which plan would be primary? The dependent's plan document states that that plan is secondary when a COBRA participant is covered under another plan in which an employee or dependent is active. The employee's plan only states that the plan that pays first is the one that covers you as an employee. This is stated under COB provisions and not mentioned under COBRA.

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deacon:

I guess I must be confused.

You have an active employee who has a dependent who is covered under his/her medical plan, but the dependent also is covered under his/her own former employer’s COBRA plan, right?

First off I don’t see how a dependent of an active employee can be covered if the dependent had his/her own coverage at his/her place of employment. Most group medical plans I’ve been involved with do not allow an employee to cover an otherwise eligible dependent if such dependent is covered for medical as an employee by any employer, which would include COBRA Coverage.

If however, this is the case I would suggest that most COB provisions would consider the coverage as an employee as promary and coverage as a dependent as secondary thus the COBRA coverage would be primary. Am I making myself totally misunderstood?

Which came first the chicken or the egg?

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I agree with you but an attorney for the hospital where the dependent has incurred claims is stating that the dependent's spouse's plan should be primary since he is an active employee. He is basing this on Thompson Publishing Group's Manual reference to the NAIC model regulation and the dependent's former employer's plan document uses the same wording. Also, it is my understanding that a person can have COBRA and other coverage as long as the other coverage was in effect prior to the COBRA qualifying event.

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I’m not sure what the attorney is referencing, but it’s my understanding that the NAIC COB provisions say that the if a person has two group medical plans and they both are using the NAIC version of COB then the plan that covers the person as an employee is primary. Therefore, since you say the person has COBRA coverage form his former employer, I would argue that the COBRA coverage would be primary.

I still fail to see how any employer allowed an active employee to continue to cover a dependent who had coverage on his own at his place of employment? I’m aware that a person can have COBRA coverage in addition to other coverage, but this person had to have been covered under his parent’s plan before he went to work and subsequently terminated employment and went on COBRA. In most employer plans once a dependent becomes covered as an employee of any employer he is no longer eligible for coverage as a dependent. Do I have the timing of events correct? If so, I challenge whether or not the person is even covered as a dependent in the other plan, thus leaving only the COBRA plan.

Sounds like a nasty divorce situation to me.

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