COBRA & out of area

[alexa]

We have an ex-employee eligible for COBRA move out of our medical plan coverage ara

Do we need to get coverage for him ?

[jsb]

Do what you would do for an active employee.

If you have a plan with an out-of-area coverage option, let the COBRA switch to it. If an active would get a new separate plan, you need to do the same for the COBRA. If it is "too bad, so sad" for an active employee and they would lose coverage access, same goes for the COBRA.

[alexa]

[Do what you would do for an active employee.

If you have a plan with an out-of-area coverage option, let the COBRA switch to it. If an active would get a new separate plan, you need to do the same for the COBRA. If it is "too bad, so sad" for an active employee and they would lose coverage access, same goes for the COBRA.

I forgot to mention we are part of a controlled group with many health plans, a couple slf-insured and many smaller fully-insured plans. If 1 of these other plans offered covergae in the state the ex-ee is moving to woudl we have to enroll him in that plan to satisfy COBRA?

To answer your question about what we are doing for actives in that particular subsidiary, there is noone out of area

[Kirk Maldonado]

If you have a plan that provides coverage in that state, I think you would have to offer it to that person who relocated there. But I'm stating that without doing any research to back up my instinctive reaction. So if somebody has actually looked into this issue, please chime in.

[leevena]

Whether there is a network or not is irrelevant, it may be a hardship or cruel, but irrelevant. If an employee is in a network plan and moves out-of-area, tough luck. They can continue the current plan and either have emergency coverage only under the HMO or out-of-network coverage for the PPO.

You may be able to allow them to change to another one of your plans, but you will need to check with those plans. Your best bet may be the self-funded, but I cannot say for sure.

[Mary C]

New HIPAA regs recognize moving out of a service area of a managed care organization as a special enrollment opportunity. If you have another plan that would cover him you will need to offer it.

[jsb]

To answer your question about what we are doing for actives in that particular subsidiary, there is noone out of area

There may not currently be any OOA's, but what would you do if you had one, cut them off or provide access to a plan? If an OOA active is TOTALLY IMPOSSIBLE, you may not need to offer anything special, but your situation with the controlled groups and such is out of my realm (large governmental plan) of experience, and I would defer to a pro seasoned in this area as suggested by Kirk.

[leevena]

Alexa....Something new occured to me this morning as I was reading the responses. Since you are part of a much larger organization that originally thought (you are part of a few insured and a few self-funded) did you not hire a COBRA administrator, or some other kind of assistance?