Impact of Disability and Medicare eligibility on employee's Cobra righ

[Guest poser]

An active employee age 67 has been disabled for 6 months. Under her plan she was considered active for the 1st 6 months of her disability, however, she has now exceeded her 6 months of being considered active under her health plan. The question is whether or not she eligible for COBRA since she is also eligible for Medicare? If she is eligible for COBRA, would she be eligible for 18 or 29 months?

[Sandra Pearce]

A participant in a health plan who is enrolled in Medicare prior to a qualifying event, or prior to enrollment in the COBRA continuation coverage, would be a qualified COBRA beneficiary eligible for COBRA continuation coverage. If the qualifying event was termination of employment the length of COBRA continuation would be 18 months. The extion to 29 months would be determined based on if and when the QB is determined by the Social Security Administration to be disabled and when the QB provides that information to the plan. (A COBRA qualified beneficiary who later - after the qualifying event or the COBRA enrollment - enrolls in Medicare would lose COBRA coverage at that time.)

[Guest AHayhow]

I have a similar question (but much more convoluted!!).

An employee left work 6/00 due to a worker's comp disability. In 12/00, the employee's paid disability terminated and the employee choose COBRA for medical coverage. Following this choice (but outside of the 60 day disability period), the employee applied for full disability to SSA. Between 3/01 and today, the employee has applied for and been denied disability status and benefits by the SSA. The employee is currently appealing the second denial.

The employee claims the disability is directly related to the Worker's Comp issue that put him on COBRA in the first place (which means he would have been disabled within the first 60 days). Does the employer have to continue to extend COBRA until the enrollee finishes the appeals process or can the employer terminate COBRA? Thanks for your help.

[Sandra Pearce]

The COBRA regulations provide that 1) the QB must be disabled at the time of the qualifying event or within the first 60 days of COBRA coverage, 2) the QB has a disability determination from the Social Security Administration stipulating to the disability at any time prior to or during the first 60 days of COBRA coverage, and 3)the disability determination is provided to the plan administrator within 60 days of when it is issued by SSA and before the end of the original 18 month COBRA period. If we had a former employee who had not received a determination for the proper period prior to the end of the 18 month continuation period we would terminate coverage at the end of the 18 month period.