Retiree Medical Eligibilty - What constitutes coverage

[Guest Mel Kiper Jr.]

Suppose you have a retiree who retired from Company A and went to work at Company B. Company A offers Retiree Medical. The Retiree Medical Plan says that if you decline coverage (which the retiree did since the retiree had coverage from Company B) or you elect the Catastrophic coverage, you will not be able to enroll in A's Retiree Medical Plan unless you can show loss of coverage under another group medical plan. This is not defined, but the Retiree Medical Plan does say this includes loss of coverage as an active employee, coverage as a dependent of an active employee, coverage as a retiree under another employer's plan, coverage as a dependent of a retiree ,or coverage under an HMO.

Former employee is on COBRA from Company B. Now wants to come back to A's Retiree Medical Plan since she forgot that A has a plan. Should COBRA coverage be treated as a loss of coverage under another group medical plan?

[lvena]

In situations like this, I always tell people to go ahead and apply, what do you have to lose? If Company A takes you back on their Retiree coverage, it becomes a non-issue issue. If the person is not eligible, the plan with A will decline and provide you with a reason.

Your post says that the person can enroll in Company A by showing loss of a group plan, which did occur. The loss of coverage issue is not with the cobra policy, rather the event/date that the group plan coverage was termed.

Is there more to this? It feels like I am missing something or maybe not understanding your question.

Hope this helps.

[Guest Mel Kiper Jr.]

In situations like this, I always tell people to go ahead and apply, what do you have to lose? If Company A takes you back on their Retiree coverage, it becomes a non-issue issue. If the person is not eligible, the plan with A will decline and provide you with a reason.

Your post says that the person can enroll in Company A by showing loss of a group plan, which did occur. The loss of coverage issue is not with the cobra policy, rather the event/date that the group plan coverage was termed.

Is there more to this? It feels like I am missing something or maybe not understanding your question.

Hope this helps.

I neglected to say that you have 31 days from the loss of coverage to apply for coverage from A's plan. Here the individual left employment many years ago, works at B. Takes Cobra from B and then remembers that A provided coverage,which was cheaper.

[lvena]

I knew I smelled something funny about the question.

I believe my initial answer to still be correct, since the cobra coverage is part of the group plan, they are still on the group plan. But you need to check Company's A documents for actual wording. I would still submit the application to Company A and put the ball in their court. If they decline, ask for explanation and go from there.

I just thought of something else, when you say 31 days from loss of group coverage, do you mean Company A's group plan (which was years ago) or some other? If from Company A, then the individual appears to be out of luck.

[oriecat]

I believe he means 31 days from the loss of another coverage to then get back onto Company A. Like the 30 days you generally have to request special enrollment due to a HIPAA event.

[lvena]

I believe he means 31 days from the loss of another coverage to then get back onto Company A. Like the 30 days you generally have to request special enrollment due to a HIPAA event.

Just re-read it, and yes, you are correct. I was answering it early this AM after 4 hours of sleep. Thanks.