COBRA PARTICIPANT FAQ
Participants
COBRA is federal legislation requiring employers to provide continuation of group
medical, dental, and/or vision benefits in the event of a loss of coverage for certain former employees, retirees, spouses, former spouses and dependent children.
Coverage is available to individuals who are covered by a group health plan
provided by an employer with 20+ employees and who have recently experienced a
COBRA Qualifying Event. The individual is then referred to as a Qualified Beneficiary (QB).
With COBRA, the QB is eligible to elect the same coverage that he/she had prior to the Qualifying Event.
For example, if the QB had an Aetna HMO plan with family coverage, he/she would be offered the same under COBRA.
Qualifying Events are certain events that would cause an individual to lose health coverage. Terminations (voluntary or involuntary), reduced hours and layoffs are qualifying events which offer 18 months of COBRA coverage. Divorce, legal separation, death of the employee, Medicare Entitlement of the employee or a dependent losing status as a dependent (e.g. no longer a full-time student) entitles the QB to 36 months of coverage.
An 11-month extension at 150% of the premium is available to a QB who is deemed disabled by Social Security prior to or up to 60 days after their Qualifying Event. A copy of the Disability Certification from the Social Security Administration must be provided within 60 days of the notice and prior to the end of the original 18-month continuation period. The 11-month extension may be terminated if a determination is made stating the individual is no longer disabled.
An 11-month extension at 150% of the premium is available to a QB who is deemed disabled by Social Security prior to or up to 60 days after their Qualifying Event. A copy of the Disability Certification from the Social Security Administration must be provided within 60 days of the notice and prior to the end of the original 18-month continuation period. The 11-month extension may be terminated if a determination is made stating the individual is no longer disabled.
Following your COBRA Qualifying Event, your former employer will report your insurance coverage termination to your
insurance companies and to us at Planned Benefit Systems. We will then send you an enrollment packet.
Remember, your coverage will not be reestablished unless you elect COBRA.
We are a third party COBRA administrator, not an insurance company. We work closely with your former employer to ensure compliance with COBRA regulations and to facilitate communication among all parties. At the most basic level, we are an intermediary between you, your former employer and the insurance companies.
Generally, your insurance will not change and you will not receive new medical cards. However, if your former employer changes plans for active employees, your insurance may also be affected.
No. COBRA coverage is retroactive to your first day after loss of benefits.
You have 60 days after the date printed on your COBRA Notification letter or the date your insurance coverage ends, whichever is later, to decide whether to elect COBRA.
Complete the enrollment form included in your packet by listing all covered dependents
(including name, date of birth, sex and Social Security Numbers) and signing it.
Then mail it back to Planned Benefit Systems. Sending a check with your enrollment documents
will expedite the process. Otherwise, you have 45 additional days from the date you
signed your enrollment form to pay all retroactive premiums and bring your account
up-to-date. Refer to the Premium Computation Form in your packet for exact amounts.
Remember, we will NOT forward your enrollment application to the insurance carrier until
one full month's premium is received.
You may drop the plans you do not want (medical, dental and/or vision) by simply
drawing a line through the benefit listed on your enrollment form.
You may also decrease your coverage level (e.g. from family to single) by writing that
on your enrollment form. Remember to adjust your premium by subtracting the
dropped/decreased coverage.
(See the Enrollment Form Option Page included in the enrollment packet for rates.)
Once Planned Benefit Systems receives your completed enrollment form and at least one month's
payment, we will update your information in our records (3-5 working days). Then,
we send the information to your insurance companies so they may update your coverage.
Please be advised that the entire enrollment process usually takes 2-4 weeks.
While your enrollment is being processed with the insurance companies, they may report
that you DO NOT have coverage. This is usually because they have not yet updated
your information in their system and re-established your eligibility.
We do ask for your patience during the enrollment process.
If you have a baby or adopt a child while covered by COBRA, your child becomes a Qualified Beneficiary and you may elect to enroll them too. You or a guardian must notify both Planned Benefit Systems and the insurance companies within 30 days of the birth/placement of the child. Failure to do so will result in forfeiture of the right to add the child to the coverage. If you get married, you may be able to add your spouse to the plan(s). Check with your insurance companies for clarification.
You may pay for the service out-of-pocket and then submit a claim to the insurance company for reimbursement. They will process your claim after the COBRA enrollment has been entered into their system. Claim forms can be obtained from your insurance companies. Or you may wish to tell your provider you are currently electing COBRA, and ask them to submit the claim for you. It may be rejected the first time if your enrollment hasn't yet been processed, but generally the second time it will be approved and paid.
After Planned Benefit Systems receives your completed enrollment form and initial payment,
we will update your information in our records and mail you a set of payment coupons.
Include these coupons with your payment so we can credit your account accurately.
If you do not have a coupon, please include the QB's name and Social Security number
on the check. You MUST make timely premium payments whether you receive the coupons or not.
If your payment is not postmarked by the applicable grace date, coverage will be cancelled
with no avenue for reinstatement.
Your COBRA premiums are due on the 1st of each month for that month
(e.g. your June payment is due June 1st). However, you have a 30-day grace period
in which your payment envelope must be postmarked. Be aware, that payments
postmarked OUTSIDE the 30-day grace period will NOT be accepted and your coverage
will be terminated retroactively. We DO NOT accept phone payments.
If you move, you are responsible for notifying Planned Benefit Systems and your insurance companies of your new address in a timely manner.
