Would a dependent turing the age of 19 be considered a qualifying even

[Guest motor]

Would a dependent turing the age of 19 be considered a qualifying event for COBRA? Maybe loss of dependent-child status?

Thanks in advance.

[Sandra Pearce]

It depends upon the definition of a dependent in the plan document. If a child who reaches age 19 no longer qualifies as a dependent in the plan, and if the plan is subject to COBRA, the answer is yes that is a qualifying event. The child would then be eligible for up to 36 months of COBRA continuation coverage.

[Mary C]

Iagree with Sandra 100% with one big IF -

The regulations state the parent or child must notify the employer or plan administrator within 60 days of the loss of eligibility to be eligible to receive COBRA continuation coverage. The plan participant can't assume they know the child turned 19 and automatically offer COBRA - most plans don't work that way.

[Guest motor]

Thanks Mary, Sandra...

Mary,

If what your saying is the case, which makes total sense to me, the employer and/or administrator would not be held legally responsible correct?

Plus the insurance carrier claims it would not honor the benifits, from what I understand, even through cobra. This seems a total disregard of cobra laws.

Viewpoints?

[Mary C]

Motor -

I'm not a lawyer, but our ERISA attorney has reviewed the cases we've had where the employee or family did NOT notify us within 60 days of the loss of eligibility for the health care plan due to no longer meeting the definition of a dependent, and we determined no COBRA was available. We've been challenged by the employee/parent and have had a complaint filed with the DOL over not offering COBRA and the DOL has backed our decision up.

Without being enrolled in COBRA coverage or eligible under the parent's coverage, it makes sense that the insurance company would not pay claims. I don't understand where COBRA laws are being violated.

mary

[Guest motor]

Mary,

I was under the impression that even if cobra was elected the insurance would not reconize the claim, BUT this part is really fogged over and I'm not totally sure of the facts.......

What I do know is that the employer knew about the dependent turning 19 and removed them from the insurance without letting the TPA know for cobra notification. The TPA found out aprox. 90 days later, which of coarse is after the required 60 days and therefore the TPA cannot be held responsible.

Sounds good to me.

Sound good to you?

Thanks...

[jeanine]

This doesn't sound good to me. First of all, make sure that you can prove that your enrollee was sent a COBRA notification form at the beginning of employment. You don't have to prove they received it, just that you sent it. If they claim they were never given an initial COBRA notification form and you can't prove otherwise through systematic record-keeping, keeping them off COBRA may not be a possibility. How is an enrollee supposed to know their rights if they are never given notice of them? As for the employer taking the child off and not notifying the TPA, the TPA may not be liable, but I think the employer still owes the child a COBRA notice. You can't disenroll someone without notice. The TPA may or may not be liable, depending on whether the TPA contracts to do COBRA administration for the plan.

[Guest dfullerton]

I agree. You must have proof that an Initial COBRA Notification or General Notification was sent to that particulare ee. Then the 60 days would come into play.