teacher - still being paid but not getting health coverage since accep

[Guest misheng]

I was employed by a Catholic Diocese for the 1999-2000 school year. I am still receiving paychecks for that position. I just accepted a teaching position in a public school system for the next school year. The Diocese has cancelled my health insurance and offered me Cobra. Two questions: Is it legal for them to cancel my health coverage if I'm still getting paid? Can I opt out of getting Cobra now, but if I end up having to go to the doctor buy it and have it be retroactive - I believe I have 60 days to do this according to Cobra law, which would put me up to my new coverage.

[Guest TSW]

I'm not a COBRA expert, but I'll chime in with what I (think I)know. Your former employer should be offering you COBRA at the time you have a qualifying event (the date you are no longer eligible for coverage under the plan). For you it would seem that that event would be when your employment terminates (you are no longer an eligible employee). I would assume that your employment is based on contract dates or on your notification to them that you do not intend to return to work.

I do not believe that you want to decline COBRA in writing during your 60 day window. If you want to protect yourself for the greatest period without paying, you would wait until near the end of your 60 day election period, and then elect ... but not pay. I beleive you then have 45 more days to make your initial payment. This gives you 105 total days to keep your option open without paying. If you decide to pay, coverage would be retroactive, but you would need to pay all of the retroactive premium.

If you decline coverage within the 60 day window, I beleive that you can change your mind, but NOT retroactively. If you responded NO on July 15 and went into the hospital on the 20th and contacted them on the 25th and indicated that you changed your mind and wanted coverage, they would not be responsible for claims incurred prior to the 25th.

[Guest misheng]

Thanks for the info. Now the confusion is the Diocese is telling me I have until July 25th to decide whether to elect or waive. But from what I read of Cobra, I believe I have 60 days (they are giving me 15). With the election, would I just not pay then? Can they come after me for the $460 at that point, or do they just send a threatening letter? Again, thank you for the info.!

[Guest TSW]

If it truly is COBRA (not some state extension of benefits provision)and they're sending you a COBRA notice, it has to be sent to you by 1st class mail (they can't just tell you verbally or hand you a notice), and you should have 60 days to respond and another 45 days to pay.... federal law.

I think if you don't pay, that they would have the legal right to sue for the premium, but most do not.

A...They might not have the legal right (I'm not sure)

but more importantly

B...It is generally not worth the effort or cost required. Most companies just let it lapse for non payment of premium.

If you think they are not giving you the proper notice or timetable, I would call your state office of the commissioner of insurance (OCI). It is likely located in your state capitol. If it is a self funded plan you might be referred to the federal department of labor office, but the OCI should have a phone number for you. TPA's & self funded groups (like the diocese) hate OCI or DOL complaints. It usually makes them stand up and fly right.

[Mary C]

Before contacting any governmental officials, did anyone consider that since she was employed by a diocese, she may very well have been covered by a church plan which is not subject to COBRA regulations? As such, they do not even have to offer her continuation of coverage and if they do, they do not have to use the same election periods and grace periods as plans subject to COBRA.

[JWK]

I echo Mary C's comment. It's likely the plan is not subject to COBRA, as a church plan, and what's being offered is a state law continuation right under the state insurance code. 15 days does not sound like an implausible election period under state law continuation, which tends to be much less favorable than COBRA.

You should read your insurance policy (certificate, policy description, or whatever other document was given to you at the time you enrolled) to figure what what kind of coverage is being offered. You may also want to contact the insurance company directly, rather than relying on your (former) employer for information.