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COBRA and HMOs


Guest mls

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Posted

Has anyone had an experience with HMOs and COBRA? We have several folks on COBRA who have HMO coverage. We have problems getting folks reinstated, terminated back several months on the HMO billing. That is because the HMO policy may only allow say, 30-days or 60-days of retroactive changes. As we all know, the COBRA election period can by law be several months when you add the period the administrator has to mail the qualifying event letter, the 60 day election period, plus 45 day payment period. Are HMOs required to follow same federal COBRA laws? In other words, can they choose not to add a participant back on to coverage even though the law says the participant has a specific length of time to elect coverage?

Posted

HMOs do have to allow the full COBRA election and payment time frames. We work mostly with HMOs and our problems usually start when we neglect to terminate the coverage from the "active" group or when the HMO doesn't get the termination into their system. I've never had a problem with a plan not allowing COBRA enrollment even when we made an administrative error and were late in getting COBRA notice to a QB.

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