Mary C

The new 125 regs allow a new election if a new plan option is added or if the coverage is substantially changed mid-year.

Most companies and plans don't allow you to be covered as both a dependent and as a primary insured by the same employer plan. By electing cobra, the spouse becomes their own primary insured on their own coverage and can't be covered as a dependent by another person.

The employer or COBRA administrator has 44 days from the date you terminated or the date you lost coverage (whichever is later) to notify you of your COBRA rights by first class mail to your last address of record. (if you've moved, you should immediately update your address with human resources) Your SPD or certificate of coverage from the insurance company should outline when coverage ends. You then have 60 days to elect coverage. If elected, coverage and the premium you have to pay is retro to the date coverage was lost. In other words, you may owe a few months premium by the time you elect coverage. You have 45 days after you elect coverage to pay the premium from the time you lost coverage to your election date. Thereafter, premiums are due the first of each month for that month's coverage. The regs do allow a grace period of 30 days after the first of each month in which you can get your monthly payment in before you can be canceled. Claims do not have to be paid until your election and/or premium payments are received. Hope this information helps and good luck.

Our insurance contract and plan allow us to cover domestic partners, but they aren't eligible for COBRA. According to COBRA, its applicable only to legally married spouse and dependent children. We interpret legally married according to the law of the state in which the employee resides - so if the state recognizes common law marriage, we extend COBRA.

Mary - I've read your posting on various threads on this board. You can check the DOL website for COBRA information. One explanation of why you show canceled 12/1 - based on the timing you gave above and elsewhere, if you terminated on 10/3, and the company's normal practice was to continue coverage to the end of the month, your COBRA period started 11/1, regardless of when you were notified or paid the first premium. You stated you sent one check. Generally under the regs, that money must be applied to purchase coverage beginning with the day after the last day you had active group coverage, or November 1. That could be why the insurance company shows you as canceled 12/1. Many people think COBRA starts when they sign the election form and return a check and that the check buys coverage going forward only. However, unless you first declined coverage then revoked that waiver within 60 days of the date you were notified, COBRA coverage begin reto to the day you lost group coverage. So if only one month's premium was paid with your election, you could have been two or three months behind in payments from the start. Good luck.

Federal regulations concerning COBRA state its only available to you for 18 months if you lose coverage due to a termination of employment (for example, your retirement is a termination of employment). These regulations do not vary from state to state. However, most states have continuation of coverage regulations that apply to insurance companies operating within the state. The state continuation provisions may be more liberal or more restrictive than COBRA and do not apply to plans that are self-insured by the employer. While Illinois law may allow certain spouses to continue coverage longer than 18 months in the event of the employees retirement or death, it does not address coverage for the retiree. You should check your summary plan description, certificate of coverage from your carrier and call your former employer or your insurance carrier for specific questions.

At our company, the continued salary is paid out in a lump sum. Coverage ends on the last day worked (termination date) and COBRA begins from that date. Again, this is spelled out in the severance agreement.

I can't comment on why there is no disability insurance - only that most regulations concerning employee benefits are written so that they do not apply to religious or government employers. As for FMLA through the carrier - FMLA stands for Family and Medical Leave Act. Under it, employers must guarantee that seniority will continue to accrue and the employee may continue to participate in benefits, the same as any active amployee while they are on the FMLA leave. It also mandates certain rights that your job may be held open until your return, depending on your position. FMLA protection is only good for 12 weeks. Any FMLA notice or request would come from your spouse's employer, not your insurance carrier. You should check with his employer for further information, not Blue Cross Blue Shield.

What does the plan document say? Our plan permits coverage paid for on an after tax basis to be dropped at any time. And anyone who is eligible but not enrolled may enroll during annual enrollment.

What does the plan document say? Our plan does not allow any enrollments outside the initial eligibility, change of family status or annual enrollment.

Can anyone tell me if the following could be considered discriminatory and if so, what the site is? 1. Different waiting periods for eligiblity for hourly paid and salaried employees (i.e., salaried employees eligible for health care from date of hire, hourly employees must wait 90 daye) 2. If coverage ends on the last day of the pay period in which the employee terminates - hourly paid employees paid weekly, salaried employees paid 2x month. The salaried employees would probably get a longer period before coverage ends.

1. You really do not provide enough information to answer if your coverage can be canceled prior to your last day worked. For example, if your coverage was contributory and you didn't make the necessary payments or deductions, or if the plan is terminated for all employees, yes, the employer may legally cancel your coverage before your last day of employment. 2.Employers are required to notify the COBRA administrator within 14 days of an employee's termination, reduction in hours, or other COBRA event. The COBRA administrator then has 30 days to notify the employee of their right to COBRA coverage (total of 44 days) by sending notice to the last address on record for the employee. 3 & 4 Yes, there are monetary penalties if a notice is not sent timely. However, the ex-employee usually has the burden of proof that it was not sent. The ex-employee is usually the one entitled to the penalties, but usually only after he/she sues the ex-employer. Monetary penalties generally are not payable if the employer can prove that they followed their regular routine of notifying the ex-employee in a timely manner and notice was sent, if the ex-employee moved and didn't tell the employer, or sometimes if the employer corrects the oversight and makes the ex-employee whole within a certain period of time. This is a very complicated part of COBRA and is usually decided in the courts and I have seen courts not grant monetary penalties when there was no harm to the ex-employee. You should probably check your specific situation and circumstances with your local Department of Labor office before going to an attorney.

Kip is absolutely correct. I'd like to also add that it is perfectly legal to change the rate you are paying once every 12 months, too, so you aren't surprised by that. By the way, Aetna's bought up a lot of HMO - US Healthcare and Prudential are two of the largest. Mary

How long has it been since your lost coverage? Besides the size of your former employer, was it a church or religious owned organization (for example, a religiously affiliated hospital), or government organization? If it wasn't a religious or government affiliated organization, and was larger than 20 employees, they would have 44 days from the date you terminated or lost coverage (whichever is later) in which to offer COBRA. Good luck!

Yes, its legal to make a change in cost or benefits outside of open enrollment. Its also addressed in the 125 regs that the employer may then permit the employees to increase their contributions for the remainder of the year, or depending on how significant the cost or change in benefits is, may allow them to revoke their current eleciton and elect on a prospective basis another option providing similar coverage. However, there's no guidance as to what is significant. Good luck with your decision.

Dropping in anticipation of a divorce is a very tricky situation. And since its happening at open enrollment when these types of changes are allowed, the employer has no way of knowing its in anticipation of the divorce unless they are specifically told. So all HIPAA notices, COBRA notices, or any notice regarding health care coverage is typically sent to the address of record - which is probably the employees home. The soon to be ex will have no way of knowing the coverage is dropped until they go to use it. Nor will most carriers recognize a voluntary cancellation (which is what dropping coverage on a dependent during open enrollment is) as a reason to offer conversion policies, if they have any (not all do). Buying a personal policy may be an option, but it wouldn't cover any expenses already incurred. As to previous questions - In our experience, although a legal separation is a COBRA qualifying event, not all states (for example NJ) have or recognize legal separations.

Regarding the 11 month extension if you are disabled -- there are certain criteria that an individual must meet in order to have COBRA extended. 1) you must have been determined by the Social Security Administration to have been disabled either at the time you first became eligible for COBRA or within the first sixty days after the termination of your active plan coverage. Although the SSA can make the determination that you are disabled at any time during the initial 18 months of COBRA coverage, the disability must have begun or existed before the end of the first 60 days of COBRA. 2) The disabled person must supply a copy of the SSA determination letter to the COBRA administrator within 60 days of receiving it and before the end of their initial 18 months of COBRA. Individual who are first disabled more than 60 days after the beginning of their COBRA coverage are not eligible to extend the coverage.

We just amended our health care plan to allow enrollments when the employee is on a LOA because HIPAA prohibits discrimination in enrollment due to health status. All are carriers are fully insured managed care organizations. Our legal and ERISA advisors interpretted this to mean we could not deny enrollment to someone newly eligible or during annual enrollment simply because they are ill and on leave.

We are a large (over 100,000 employees), nationwide company who have always enrolled new spouses as of the date of the marriage if the forms to enroll them are completed within 31 days. Because forms are usually not completed till after the marriage, the enrollments are by necessity retroactive. In addition, I checked the certificate of coverage from a few of our larges HMO's and they state that, too. Can you give me the site that says we are not permitted to do this?

Also, you should be aware that the time period for notifying you is 44 days, not 14 days, from the date you terminated or lost coverage. Usually sending a letter to the COBRA administator (who sent you the COBRA notice)and your employer's HR dept. (not just your store location)along with a copy of your last pay stub showing a deduction will get them to correct their records. Since you definitely need the coverage, elect now and pay back to 10/11 if need be until the dates gets straightened out. Good luck.

It would depend on how your AD&D plan is written. We've written ours to allow changes due to change in family status such as birth of a child, but I've seen plans written where changes are allowed only at annual enrollment. If changes due to a status change are allowed, they are usually effective the date of the event so the accident the day after the birth would be covered. The special enrollment period in HIPAA applies only to medical plans.

This comes back to the question of can a plan enforce an actively at work provision for enrollment/changes. HIPAA states that group health plans cannot discriminate on enrollments due to health status. There have been cases filed with the courts and ADA to see if an actively at work provision discriminates against employees on a medical LOA when it comes to enrollments and making changes active employees would be allowed to make. We allow employees on LOA to go ahead and make the changes for several reasons -- for example, their current HMO may no longer be offered.

First place I'd look is the bargaining agreement negotiated by your union.

The only way you can offer money to opt out and get other coverage and NOT run afoul of the Medicare as secondary payer regs is if you offer the same amount to everyone eligible for the plan.

Nikki - its when they enroll. You don't have to send the notice to employees prior to enrollment or those that don't enroll. Also, the notice should be sent to any family member covered. While you may be able to get away with addressing it to Mr.(or Ms.) Employee and Family for those dependents who live with the employee, the regs require you send a separate notice to those dependents that are being covered that do not live with the employee (if an address is provided). There's statutory language out there for this initial notice.