Florida small group insurance

[Guest llerner]

A friend of mine lives in Florida and her brother who just retired at age 53 from his practice, was in an accident that was his fault and is now paralyzed. He has a small group plan for 1 (permitted there). Florida has min-COBRA for small groups not covered by Federal COBRA. My friend said that his broker said that he was not eligible because he was part of P.A.

I am assuming that means physicians association. It is through United Health Care PPO plan. Does anyone know what this means as far as COBRA is concerned. Someone said maybe it is an individual plan sold by out of state brokers that are ineligible under Florida mini-COBRA since association plans are not excluded from COBRA. I try to get info from the carriers but everything is confidential even more so now and it is also a convenient way to side step any issue and not do anything. If anyone can shed light on the term P.A. (it is on his ID card as well). The id card states small group PPO plan and the group name is his name. The costs are astronomical and he will be completely broke, besides everything else.

Thanks!

[GBurns]

You should not be relying on what your friend said that the broker said. Your friend should not be relying on what that or any broker says, Ask the insurance company and check the policy.

Since the brother is paralyzed, your friend needs to get Power of Attorney at least for this issue.

COBRA or mini-COBRA, whether in FL or anywhere else costs more than the current insurance premium, so I do not think that your friend's brother should be trying to get on any COBRA. What he should be doing is trying to get coverage before his HIPAA period runs out for guaranteed isuue coverage.

P.A means Professional Association which is a type of corporate structure used by Drs, lawyers, egineers, architects etc and should have no bearing on the issue. A call to the State Dept of Insurance will get you their answer as to whether or not being in a P.A has any relevance.

[Guest asire2002]

I agree with GBurns that you should not be relying on statements made by a broker, but am not sure I agree on whether COBRA or an individual policy is preferable. Clearly there will be cost differences between the two but it seems of paramount importance that the insurance cover the existing expenses, and I can't believe any individual policy would be retroactive.

Anyhow, I was interested in the suggestion that this guy might not be eligible to elect mini-COBRA because he was a P.A. P.A. does stand for Professional Association and that type of business organization is a corporation, but the suggestion was that this individual was not eligible because he was the owner of the business rather than its employee.

I took a look at the Florida statute, which is in Chapter 627 starting at Section 627.6692. It indicates that an "eligible employee" who is or was provided coverage under a "group health plan" by virtue of his employment or previous employment with a "small employer" is eligible. An "eligible employee" includes a self-employed individual if the individual is included as an employee under a health plan of a small employer. See 627.6699(3)(h). A "small employer" includes any corporation that is engaged in business who employed an average of at least 1 employee during the preceding calendar year and employes at least 1 employee on the first day of the plan year.

Based on my reading of the statute, I do not believe your friend's brother is ineligible for mini-COBRA simply because he was a P.A. To get continued coverage under mini-COBRA, however, your friend needs to notify United in writing of the qualifying event (retirement/termination of employment) within 30 days of the event, and then United should send an election and premium notice form to him within 14 days of their receipt of that notice, and then you have 30 days to make the premium payments, which can be as much as 115% of the prior premium. You have to document everything in writing and send everything in a way that can be verified, such as certified mail or an overnight delivery service.

Your situation is very fact-specific and so I cannot say absolutely that your friend is eligible for mini-COBRA, but I don't see why he shouldn't be. However, you should get a hold of the insurance policy/contract, the certificate of coverage, and/or the coverage booklet to see what those documents say. But don't rely on them completely, as I've seen booklets by this carrier that are inaccurate and misleading. Also, the Florida Department of Insurance can help.