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COBRA if leaving the area?


Guest DoctorZen
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Guest DoctorZen

Cannot find info on whether COBRA can be kept if you move out of state. Have heard conflicting advice- yes, you can- and no, it is cancelled if you leave the service area. If you cannot take it with you, it seems to be of very limited value- people are more mobile today then ever. Any advice/info? Please email me. Thanks. David

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I've always understood the rule to be that the employer has to offer COBRA coverage under the existing health plan arrangement, even if the qualified beneficiary lives outside of the service area. Then, if the qualified beneficiary wants to pay for COBRA coverage that can't be utilized, so be it.

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Check the new COBRA 2000 regulations available from numerous websites on Benefitslink. You may have to go back a few weeks or months. The new regs. say that as long as an employer offers a benefits program that the employee can utilize, they must be given the COBRA option. Two examples are most often given. 1)Plan is a PPO; employee can use any provider and pay the out of network difference; 2)Plan offers both an HMO and PPO; employee must be allowed to switch from HMO to PPO if this enables employee to participate in plan.

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Guest DoctorZen

More specifically: I have United HMO, work for a national company that has employees in the new area. United is also in the new area. I am not transferring with the company.Wife has United HMO, does not work for a company with employees in the new area, but United is in the new area. Does COBRA require coverage for each of us since the same health plan provider serves the new area? If PPO is offered, is PPO required to be made available to the departing employee at the time of COBRA enrollment, or only at the time of open enrollment for active employees? Naturally, most laws are made complex enough so that a lot of folks would rather just give up then to try to comprehend them, eh??? Thanks for any feedback.

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Dr. Z: I agree with Jeanine. However, if your employer only offers an HMO plan to employees and it does not have a service area in the location you are moving to, I do not believe they have to offer COBRA to you. In addition, I believe United HealthCare is set up with as a different corporation in each state. How's that for confusing?

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Guest DoctorZen

All I know is that I visited the United site-they have an area to search for participating providers in any state/area, and my search produced a long lists of providers in the area I am moving to....?

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Guest DoctorZen

I called United- they say that while they in fact are a national company, the plans are administered at a local level, so to leave the local service area one would only be covered for urgent care and emergency care. Also, they said that to be in a PPO you either pay an 'in area' deductible, or an 'out of area' deductible. There must be an easier way to solve this dilemna? 20,000 people move into Arizona yearly, and 7,000 people move into Florida every WEEK- using that as an example, would that many people leave their service areas and forfeit health insurance? (Yes, in each case a lot of those people are older and Medicare eligible, but I suspect less than 50%- that would leave a lot of uninsured people moving around, eh?)

Comments/info/resources? Thanks.

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At this point I think I would call United Healthcare. If United also provides the COBRA administration for your employer, they should be able to give you the most accurate advice as to whether your coverage will be portable. I understand your reluctance in not wanting your employer to find out you are thinking of leaving but I would be reasonably sure that a call to the health plan would not tip them off.

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Dr. Z: United HealthCare is a national company. However, the company does issue different plans based on your state of residence. I am told this is done to make it somewhat easier to deal with each State's different legislation. (Each state has a Department of Insurance which regulates insurance companies in that State.)

If your employer offers both HMO and PPO plans (not sure based on your prior post) I believe you do have the right to change to the PPO plan when moving out of state. If there is a PPO network in the area you are moving to, you may be able to access that network at the in-network level of benefits. Again, you should probably ask United this question. Also, if you move to an area where there is no PPO network but you change to the PPO option, you would be covered at the out of network level of benefits. You, in fact, would have coverage even though it may not be your ideal plan.

If you only have the HMO choice, I believe the HIPAA legislation mandates you can purchase individual health insurance plans from any carrier who markets them in the state you are moving to on a guarantee issue basis. However, if you have conditions that the individual insurance company feels warrant a higher rate, they can charge it.

Last, if you are going to be employed by a new employer in your new state, do they offer an employer sponsored plan? You may only need to stay on COBRA or an individual plan until you satisfy the new employer's service requirement prior to enrolling in their plan.

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Guest DoctorZen

Has anyone reading this board moved to another state and had COBRA availablity/continuation issues? Am interested in any feedback- I only have '5 months' to figure out this madness...

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Guest [Pat M]

You sound so frustrated...wish it was easier for you. A friend of mine just left a job in NY to move South. He was offered COBRA by his former employer (PPO), at the typical 102% of premium charge. He was shocked at what the premium would cost him for the COBRA coverage. However, he called around to some of the local HMOs in his new telephone book, and found a plan that would provide acceptable coverage at a lot less money, until his new employer's insurance kicks in. He did have to apply by completing an application, but the HMO approved him before his Cobra election period ended. In any event, he could have still elected COBRA in time, because the new carrier processed his application in a few weeks.

You may want to shop around, too. Just a thought. Try it online using a yellow pages site...see if you can send HMOs an e-mail request for a quote & a provider directory for your new area. Make sure you understand when your new coverage will begin, if you decide not to go with COBRA, and leave yourself enough time to elect the COBRA in case you can't get coverage.

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My wife and I are moving to Miami, FL from Maryland at the end of March. We have United Healthcare and she is 5 mos. pregnant. I have not informed my current company that I am leaving and would like to know if Cobra will be available to me in Miami. Will it cover her delivery and medical fees. Currently our plan is fantastic and we have paid only $10 per doctor visit.

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Guest DoctorZen

This is a summary of what I have found:

If you have HMO, you can pay to keep that but it will only cover urgent/emergency care-the employer is not required to offer additional coverage.

If you have indemnity, you can take that with you.

If you have PPO, you can take that with you, and pay the 'out of service area' deductibles/copays instead of the 'in service area' deductibles.

If your current employer offers a plan aside from the HMO (PPO/indemnity), you have to be allowed to switch to one of those when you leave your current area, so you will have coverage in the new area.

If your employer has active employees in the area you are moving to, and offers those employees coverage, the company has to allow you to obtain the same coverage there that the other employees have.(This does not mean that you have to transfer to a job with the employer).

If none of the above apply, but you have had group coverage in the past 30 days, then any 'guaranteed issuer' of individual policies (a company that will accept any apllicant for insurance)will take you on, and they cannot exempt any pre-existing conditions- but there is no limit to how much they can charge you for premiums (this is in accordnace with HIPAA, the federal law).

If yet none of the above apply, your options are to try for an individual policy, or try the state's high risk pool.

Anybody have anything new to add? I would have thought that this issue would have been a 'no brainer' considering the thousands of people that move around in this country every day, but I have found this issue to be a not very common topic?

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