COB & COBRA

[Guest MartyH]

Our self funded plan covers an employee and spouse. The spouse has COBRA through her former employer. The spouse's former employer states her claims are covered by them only as secondary since she is on COBRA and her husbands plan would be primary. Is this typical of COBRA, being secondary to other Plans or is this something tha would specially be indicated in their SPD?

[GBurns]

If they are fully insured, it would be something indicated in their master policy.

If they are instead self-insured, it depends on what their PD says assuming that it does not conflict with their SPD.

What does yours say about dependent coverage and situations at conflict?

In any case, are you stating that this spouse has dual coverage? I usually see that COBRA is dropped when other coverage is secured. What happened in this case?

[mroberts]

COB issues vary from plan to plan, region to region and state to state. As far as I'm aware of, there is nothing in the COBRA regs that deems which plan would be either primary or secondary. Just out of curiosity, why is this person on COBRA and your health plan? I know it's possible that there could be some advantage to this depending on the richness of either plan, however, it is very unlikely. If this person wants to waste a couple hundred bucks a year, I'd be more than happy to forward you my mailing address.

[Kirk Maldonado]

Here's an article that might shed some light on this topic, although it is admittedly not directly on point:

http://benefitslink.com/articles/coordinat...ate011008.shtml

[GBurns]

I guess this means that absent language in your self-insured plan, the COBRA plan which covers this spouse directly would be primary, if I read Kirk's cite correctly.

[Guest MartyH]

Thanks for all the help. We have requested a copy of the order of benefit detemination outlined in the spouse's SPD. Our plan (the husband's) states "the plan which covers the person on whose expense a claim is based as a Dependent of an Active Employee shall be determined before the benefits of a plan which covers such person as a former employee or a dependent of a former employee". This makes it a little more confusing as our employee is also a "former employee". Although he is not on COBRA, he is only eligiible through his hour bank with hours he accumulated while working under our collectively bargaining agreement. As of 1/1/03 he transferred to another plan and while he is gaining eligibility with the new plan he has enough hours to run out his hour bank with continuing coverage under our plan.

Just glad to know this was not a "known COBRA fact" and I was the only "unenlighten one" out here.