COBRA Dependent coverage

[Guest Gibson]

We have a situation where a covered dependent lost coverage under our plan effective Jan. 2000 due to his ceasing to be a dependent under the terms of the plan (i.e., he turned 19 and was not a full-time student). As a matter of practice, when covered dependent turns 19, our TPA sends the dependent a notice that coverage is terminating and the dependent or the employee-insured needs to notify them with respect to whether full-time student status is maintained.

In this case, the dependent, who is not a full-time student, did not reply. We never sent COBRA election forms. Recently, the dependent and the insured have come to us and asked for COBRA. Can we give him COBRA now? Can we do it retroactively, assuming he pays the premiums?

[Guest lmrice]

You do have the responsibility to offer COBRA to this dependent for 36 months. You would use the same loss of coverage date, and he would have a 60 day election period to enroll - starting from the date you provide notice. He would also have the same 45 day period (from when he elects COBRA during the initial 60 day election period) to make payment. He would be responsible for paying the premiums from January to present.

Hope this helps.

[Mary C]

The employer may not be required to offer COBRA coverage to the dependent. According to the COBRA regs, (4980B(f)(6)©) the employee or the dependent is responsible for notifying the employer within 60 days of a loss of dependent status, including a dependent child ceasing to be a dependent child under the plan. If the employee or dependent does not notify the employer within 60 days, then COBRA does not have to be offered.

[Joe Priselac]

Mary C is correct assuming that a proper initial COBRA notice was done when the employee first became eligible for benefits.Without proper notification, the employee or the dependent could argue they had no knowledge of the requirements.

[KIP KRAUS]

On the same line of thought as Mary and Joe, my theroy is that if your COBRA prcedures are not squeaky clean don't deny COBRA benfits using a technicality. Just my theroy

[Guest Rob Cochran]

I agree with Kip. If the QB is requesting COBRA and willing to pay for it, It's better to offer than run the risk of having your COBRA procedures examined in court. You're carrier, on the other hand, may not be willing to retroactively enroll the the QB since they did not notify you within 60 days. I would check with the carrier first to see if they'll even allow the retroactive enrollment. If the carrier is willing, then I would offer COBRA.

[Guest KGibson]

I have had a situation very similar tested in a litigation matter - which our company won. The qualified beneficiary is responsible to notify you w/in 60 days of the qualifying event and that is very clear in the COBRA regs. If you make exception, are you willing to make exception to every case? Also, if self insured, will reinsurance honor claims? These are very important issues to also consider. The letter sent to the participant when the dependent turned 19 can also be considered an effort to have assisted the dependent in meeting their requirements to notify you which clearly did not happen.