COBRA question

[Guest SScannell]

Hi all,

Looking for solid information to backup/prove wrong an assumption. Situation is: person laid off, went on COBRA, is rehired within the same plan year. Question is, becuase there was no break in coverage (significant or otherwise), shouldn't the employee's accumulators continue/remain rather than be reset? For instance, if the employee had already met $400 towards a $500 deductible, shouldn't that accumulator stay as is? OR, when s/he re-enrolls in the plan as a new hire, would s/he have to start at $0 having been met towards the deductible?

My assumption is because 1) it's the same plan year, 2) there was no break in coverage due to continuance through COBRA, and 3) in the same scenario you wouldn't have to meet a pre-existing condition clause again, the same would be true of accumulators (whether deductibles, OOP Max, co-ins max, etc.).

The plan document is silent other than to state a rehire will become eligible on the first of the month after re-hire. I cannot find any info. in the EBIA COBRA manual to backup my assumption.

Any input would be appreciated. Thank you!

[Guest Sieve]

I would assume you are correct. But, that being said, isn't it a contractual issue that ought to be (and may be) covered in the insurance contract?

[Guest SScannell]

I would assume you are correct. But, that being said, isn't it a contractual issue that ought to be (and may be) covered in the insurance contract?

It's a self-funded plan therefore no insurance contract, just the SPD to rely upon. Thank you for responding - appreciate it.

[Guest Sieve]

Clearly, deductibles and other limits must carry over into the COBRA coverage (Treas. Reg. Section 1.4980B-5, Q&A-2), but it would surprise me if there are any requirements for carryover in the other direction (i.e., from continuation coverage back into the main health plan).

[Guest SScannell]

Clearly, deductibles and other limits must carry over into the COBRA coverage (Treas. Reg. Section 1.4980B-5, Q&A-2), but it would surprise me if there are any requirements for carryover in the other direction (i.e., from continuation coverage back into the main health plan).

Agreed - all needs to carry over into the COBRA coverage. Question is does it need to carry back into the main health plan upon rehire within the same plan year. Wondering if there's info. I'm unaware of within the employee contract/handbook, etc. so I'm having that researched also (I'm with the TPA, not the employer). This is all good info - thanks again.

Sheila

[FormsRstillmylife]

COBRA governs who is covered for how much for how long. COBRA does not create a separate group health plan. There is no carrying of rights, etc. between two plans, there is just one plan.

[masteff]

COBRA governs who is covered for how much for how long. COBRA does not create a separate group health plan. There is no carrying of rights, etc. between two plans, there is just one plan.

I concur w/ this answer 100%.

Going back to the OP, the plan is likely silent on rehires because I think you'll find the items in question are defined on an annual basis. So, same plan, same year, pick up and carry on from where they left off.

[Guest JKosciusko]

Very much agree with one plan answers. Could this be an administrative issue with the insurer/TPA? They generally take you out of the general population once you are on COBRA. Could the re-entry be causing the system to inappropriately do this? Just a guess.