COBRA, refers to the Consolidated Budget Reconciliation Act of 1985, and specifically to Title X of the Act. The provisions of Title X include provisions to provide members of company health plans who have lost their coverage due to a “qualifying event” to continue coverage at the employee’s expense for a period of time.The term health insurance is commonly used to describe any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance or a social welfare program funded by the government.for this usage include health coverage and health care coverage..
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In a more technical sense, the term is used to describe any form of insurance that provides protection against the costs of medical services. This usage includes private insurance and social insurance programs such as Medicare,which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs such as Medicaid and the State Children’s Health Insurance Program, which provide assistance to people who cannot afford health coverage.
COBRA also allows for coverage for up to 18 months in most cases. If the individual is deemed disabled by the Social Security Administration, coverage may continue for up to 29 months. In the case of divorce from the former employee, the former spouse’s coverage may continue for up to 36 months. In the case of death of the former employee, the widow’s coverage may continue for up to 36 months.COBRA does not apply, on the other hand, if employees lose their benefits coverage because the employer has terminated the plan altogether or if the employer has gone out of business.
Q1. What is COBRA in general?
Answer: – COBRA is acronym for The Consolidated Omnibus Budget Reconciliation Act introduced in 1985, the act is an adduct to group health plan that adds continuous benefits if availed. The coverage provided under COBRA health insurance is known as COBRA coverage. A well built documentation covering every single aspect of COBRA including COBRA health insurance was released in June 15, 1987 and of January 7, 1998. A final documentation and regulation is drafted on the basis of these two proposed regulations.
The new regulation drafted has included group health plans and has issued guidelines both for participants and administrators.
Q2.What is COBRA continuation health insurance?
Answer: – The most debated and landmark continuation health insurance most popularly known as COBRA health insurance 1986 was passed by congress. There are array of amendments but most effective once are that deal with Income Security Act, the Internal Revenue Code and the Public Health Service Act which enables prolongation of group health coverage that may have been terminated.
Q3.What does COBRA do?
Answer: – COBRA basically allows continuation of health coverage at group rates on temporary basis. COBRA health insurance however can be availed if the existing coverage is lost in wake of any special event. The primary reason why one can want to avail COBRA is the reason that it is much more cheaper that individual health coverage plan.
Q4.How can you become eligible for COBRA continuation coverage?
Answer: – Anyone who has enrolled himself for employer’s health plan can avail benefits of COBRA health insurance.
Q5.What group health plans are covered under COBRA?
Answer: – Arrays of health plan are covered under it but major once are those maintained by private sector employers with an employee base of 20 or more or state governments.
Q6: What process must individuals follow to elect COBRA continuation coverage?
Answer. Employers must notify plan administrators of a qualifying event within 30 days after an employee’s death, termination, , reduction of employment hours or entitlement to Medicare. A qualified beneficiary must notify the plan administrator of a qualifying event within 60 days after divorce or legal separation or a child’s ceasing to be covered as a dependent under plan rules.Plan participants and beneficiaries generally must be sent an election notice not later than 14 days after the plan administrator receives notice that a qualifying event has occurred. The individual then has 60 days to decide whether to elect COBRA continuation coverage. The person has 45 days after electing coverage to pay the initial premium.
Q7: How long after a qualifying event do I have to elect COBRA coverage?
Answer.Qualified beneficiaries must be given an election period at least 60 days during which each qualified beneficiary may choose whether to elect COBRA coverage. This periofrom the later of the coverage loss date or the date the COBRA election notice is provided by the employer or plan administrator.The election notice must be provided in person or by first class mail within 14 days after the plan administrator receives notice that a qualifying event has occurred. The Trade Adjustment Assistance Act of 2002 embded COBRA to provide certain trade affected workers with a second moment to elect COBRA continuation coverage. Qualified workers will have a second opportunity to elect COBRA continuation coverage and will receive a 65 percent tax credit to help pay for the premiums. Individuals who are eligible for trade adjustment assistance (TAA) or alternative trade adjustment assistance (ATAA) and who did not elect COBRA during the general election period may get a second election period. This additional, second election period is measured 60 days from the first day of the month in which an individual is determined TAA-eligible. For example, if an individual’s general election period runs out and he or she is determined TAA-eligible 61 days after separating from employment, at the beginning of the month, he or she would have approximately 60 more days to elect COBRA. However, if this same individual is not determined TAA-eligible until the end of the month, the 60 days are still measured from the first of the month, in effect giving the individual about 30 days. Additionally, the Trade Act of 2002 added another limit on the second election period. A COBRA election must be made not later than 6 months after the date of the TAA-related loss of coverage.
Q8: How do I file a COBRA claim for benefits?
Answer:Health plan rules must explain how to obtain benefits and must include written procedures for processing claims.The process for filing a claim under a COBRA plan is the same process as a COBRA alternative plan and most,all other private health insurance plans. As a practical matter, most claims are filed electronically by the doctor hospital who performed the service.The vast majority of medical insurance claims are quickly processed, and paid under this system without any effort on the part of the plan participant.However, this does not relieve the participant from obligation of making sure that the claim is filed with the health plan. If no benefits response is received from a health plan with in month of the date of treatment,it would be wise to follow up on the claim submission to confirm that a claim was properly filed. if the claim is denied, you must be given notice of the denial in writing generally within 90 days after the claim is filed.The notice should state the reasons for the denial,any additional information needed to support the claim,and procedures for appealing the denial.You will have at least 60 days to appeal a denial and you must receive a decision on the appeal generally within 60 days after that.
Q9: Can individuals qualify for longer periods of COBRA continuation coverage?
Answer:Yes, disability can extend the 18 month period of continuation coverage for a qualifying event that is a termination of employment or reduction of hours To qualify for additional months of COBRA continuation coverage, COBRA offers you continuation coverage. That’s simply continuing the same coverage you had the day before you lost your coverage. If you choose to elect COBRA coverage, you cannot be denied coverage based on your medical history,and you are not required to provide proof of insurability. For many people, COBRA provides peace of mind during a difficult time.The monthly premiums are set each March by the Board of Trustees and do not change for 12 months.The cost is determined by the type of coverage you elect and whether you are buying coverage for yourself or for both yourself and your family.The duration of coverage can be from 18 to 36 months. Generally, coverage is for 18 months, but can be extended to 36 months if a second qualifying event occurs or to 29 months if Social Security determines that a qualified beneficiary is totally disabled.
Q10: Is a divorced spouse entitled to COBRA coverage from their former spouses’ group health plan?
Answer.Under COBRA, covered spouses and dependent children may continue their plan coverage for a up to 36 months when they would otherwise lose coverage due to divorce or legal separation. A qualified beneficiary must notify the plan administrator within 60 days after divorce or legal separation. After being notified of a divorce, the plan administrator must give notice, generally within 14 days, to the qualified beneficiary of the right to elect COBRA continuation coverage.
Q11: If I waive COBRA coverage during the election period, can I still get coverage at a later date?
Answrer:In which receiver may revoke the waiver of coverage before the end of the election period , then they elect their COBRA coverage.Then, the plan need only provide continuation coverage beginning on the date the waiver is revoked.
Q12:Under COBRA, what benefits must be covered?
Answer:The medical, dental, and vision plans offered by your employer are all included under the COBRA continuation of benefits guidelines.However, you may continue only those plans in which you were enrolled on the date of your loss of eligibility. For example,if you were enrolled in a PPO medical plan and the vision plan, you may continue either or both of those two plans.You would be ineligible to elect participation in a dental plan, and ineligible to change to an HMO medical plan, until the next annual Open Enrollment period.COBRA coverage is generally offered for up to 18 months, or longer depending on the circumstances. When you or a covered dependent lose eligibility for or end your coverage in our benefits plans,the coverage will be terminated. However, under most circumstances, you may continue the medical prescription,dental, vision and health care flexible spending account benefits coverage through COBRA. Under COBRA, you will pay the full group cost of the plan, plus a 2% administrative fee.
Q13:When does COBRA coverage begin?
Answer.COBRA coverage begins on the date that health care coverage would otherwise have been lost by reason of a qualifying event.
Q14: How long does COBRA coverage last?
Answer:If you are leaving your job and you had group coverage, you may be able to stay in your group plan for an extended time through COBRA or state continuation coverage. The information presented below was taken from publications prepared by the U.S. Department of Labor.You should contact it for more information about your rights under COBRA.The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows for, according to the United States Department of Labor, “continuation health coverage.” The government-funded group insurance works by giving workers who have been fired or laid off from their jobs the chance to continue their health insurance until they find another job. COBRA typically lasts up to 18 months, but there are some exceptions.To do so, they must provide proof of a ruling from the SSA within 60 days of receiving COBRA benefits.This can add up to an additional 11 months on the COBRA coverage. Within 30 days of the “qualifying event,” your employer will contact you with information on receiving COBRA.You must respond within the date listed.Second qualifying events must be reported within 60 days. The COBRA payments are due within 45 days of accepting coverage.
Q15:Who pays for COBRA coverage?
Answer:Receiver may be required to pay for COBRA coverage.The grant cannot exceed 102 percent of the cost to the plan for similarly situated individuals who have not incurred a qualifying event,including both the portion paid by employees and any portion paid by the employer before the qualifying event, plus 2 percent for administrative costs.For qualified beneficiaries receiving the eleven month disability extension of coverage, the premium for those additional months may be increased to 150 percent of the plan’s total cost of coverage.COBRA premiums may be increased if the costs to the plan increase but generally must be fixed in advance of each 12-month premium cycle.The plan must allow you to pay premiums on a monthly basis if you ask to do so, and the plan may allow you to make payments at other intervals(weekly or quarterly).The initial premium payment must be made within forty-five days after the date of the COBRA election by the qualified beneficiary. Payment generally must cover the period of coverage from the date of COBRA election attendant to the date of the loss of coverage due to the qualifying event.Grants for successive periods of coverage are due on the date stated in the plan with a minimum thirty-day grace period for payments. Payment is considered to be made on the date it is sent to the plan.If premiums are not paid by the first day of the period of coverage,the plan has the option to cancel coverage until payment is receive and then reinstate coverage retroactively to the beginning of the period of coverage.If the amount of the payment made to the plan is made in error but is not significantly less than the amount due, the plan is required to notify you of the deficiency and grant a reasonable period to pay the difference.The plan is not bind to send monthly grant notices. COBRA receiver remain subject to the rules of the plan and therefore must satisfy all costs related to co-payments and withdraw, and are subject to fatal and other benefit limits.
Q16:if i elect cobra how much do i play??
Answer: It’s very important to know your rights under COBRA – and your responsibilities as well.There are certain procedures you must follow. For example, if you fail to sign up within the initial election period, you’ll miss your opportunity to choose continued health coverage under your employer’s plan.And, if you don’t make your monthly premium payments by the specified date, your COBRA coverage will end…When you elect COBRA,your coverage is retroactive.That is, your coverage will be effective from the date your coverage was lost under the health plan, and you will have no “gap” in coverage.COBRA provides continued benefits for the employees’ spouse and other dependents after the employee leaves the job or reduces hours.The Family and Medical Leave Act, effective August 5, 1993, requires an employer to maintain coverage under any group health plan for an employee on FMLA leave under the same conditions coverage would have been provided if the employee had continued working. Coverage provided under the FMLA is not COBRA coverage, and FMLA leave is not a qualifying event under COBRA. A COBRA qualifying event may occur, however, when an employer’s obligation to maintain health benefits under FMLA ceases, such as when an employee notifies an employer of his or her intent not to return to work.
Q17: Can,the COBRA Premium Reduction (Subsidy) ends on August 31, 2011, is this true?
Answer:No,this is not important some individuals are still eligible to receive the subsidy beyond August 31, 2011.The American Recovery and Reinvestment Act (ARRA) provided a COBRA premium reduction for eligible individuals who were involuntarily terminated from employment through the end of May 2010.Due to the statutory sunset, the COBRA premium reduction under ARRA is not available for individuals who experience involuntary terminations after May 31, 2010.However, individuals who qualified on or before May 31, 2010 may continue to pay reduced premiums for up to 15 months, as long as they are not eligible for another group health plan or Medicare even if their COBRA coverage did not start until a later date due to the terms of a severance arrangement, or the use of banked hours or other similar provision that delayed the start of their COBRA coverage.For example if an individual was involuntarily terminated on May 31, 2010 and due to the terms of a severance agreement their COBRA coverage did not start untildecember 1, 2010, they would still be eligible for the full 15 months of subsidy through February 29, 2012 as long as they are not eligible for another group health plan.
Q18: If I did not make the premium payment on time and my coverage was canceled what can I do?
Answer:You may want to contact your plan and ask if they will reinstate your coverage; however, if your coverage was terminated for not making the payment within the grace period, the plan is not required to reinstate your coverage. If you believe your coverage was canceled inappropriately.If you have lost coverage, and are not eligible to enroll in a new employer’s plan or a spouse’s plan, you may want to contact your state department of insurance to get information about obtaining an individual policy. the Affordable Care Act provides that plans or issuers that make available coverage to dependent children must make such coverage available for children up to age 26. Because this provision has a varying applicability date, contact the plan to see if such coverage is available.The Affordable Care Act also established Pre-existing Condition Insurance Plans (PCIP) for those with pre-existing conditions.
Q19: Can we receive COBRA benefits while on FMLA leave?
Answer:The Family and Medical Leave Act, effective August 5, 1993, requires an employer to maintain coverage under any group health plan for an employee on FMLA leave under the same conditions coverage would have been provided if the employee had continued working. Coverage provided under the FMLA is not COBRA coverage, and FMLA leave is not a qualifying event under COBRA. A COBRA qualifying event may occur, however, when an employer’s obligation to maintain health benefits under FMLA ceases, such as when an employee notifies an employer of his or her intent not to return to work.
Q20: what changes did the trade act of 2002 and the trade adjustment assistance extension act of 2011 make with regard to cobra continuation coverage?
Answer.The Trade Act of 2002 created a tax credit for certain individuals who become eligible for trade adjustment assistance and for certain retired employees who are receiving pension payments from the Pension Benefit Guaranty Corporation (PBGC). Under the tax provisions, eligible individuals can either take a tax credit or get advance payment of 65% of premiums paid for qualified health insurance, including continuation coverage.The Trade Adjustment Assistance Extension Act of 2011 increased the percentage of the Health Coverage Tax Credit (HCTC), extended eligibility for qualifying family members, and extended COBRA coverage. These changes are effective through January 1, 2014.In January 2012, the monthly HCTC will increase to 72.5 percent of qualified health insurance premiums and individuals began paying 27.5%.COBRA coverage can be extended through the former employer’s plan for TAA recipients and PBGC payees whose COBRA end date is on or after November 21, 2011. TAA recipients are eligible for COBRA coverage extensions for as long as they have TAA eligibility or until January 1, 2014. PBGC payees are eligible for COBRA coverage extensions until January 1, 2014. If the payee passes away, their spouse or dependents can receive an additional 24 months of COBRA or until January 1, 2014. The law also extends the HCTC to family members for 24 months after the covered employee passes away, enrolls in Medicare, or finalizes a divorce, or until January 1, 2014. The extension also applies for 2011,therefore payments made directly to the qualified health plan can be claimed. Starting in January 2012 qualified family members can enroll in HCTC.
Q21: What is the Federal Government’s role in COBRA?
Answer: COBRA continuation coverage laws are administered by several agencies. The U.S. Department of Health and Human Services administers the continuation coverage law as it affects public-sector health plans.The Treasury Department has interpretive responsibility to define the required continuation coverage. The Internal Revenue Service, Department of the Treasury, has issued regulations on COBRA provisions relating to eligibility, coverage, and payment. The Departments of Labor and the Treasury share jurisdiction for enforcement of these provisions.COBRA continuation coverage laws are administered by several agencies. The Departments of Labor and the Treasury share jurisdiction over private-sector group health plans. The Department of Health and Human Services administers the continuation coverage law as it affects State and local government health plans.
Q22: I am a federal employee. Can I receive benefits under COBRA?
Answer.Federal employees are covered by a law similar to COBRA. Those employees should contact the personnel office serving their agency for more information on temporary extensions of health benefits.
Q23: Am I eligible for COBRA if my company closed or went bankrupt and there is no health plan?
Answer:Federal employees are covered by a law similar to COBRA. Those employees should contact the personnel office serving their agency for more information on temporary extensions of health benefits.When your employer went out of business, the group health insurance pool to which you belonged also ended. You’re not eligible for COBRA coverage because there is no longer a group under which you could continue your group health insurance benefits. Likewise, if you had already left your employer, enrolled in COBRA, and then your employer went bankrupt, your COBRA coverage would end.
Q24: How do I find out about COBRA coverage and how do I elect to take it?
Answer: Employers or health plan administrators must provide an initial general notice if you are entitled to COBRA benefits You probably received the initial notice about COBRA coverage when you were hired. Employers must notify their plan administrators within 30 days after an employee’s termination or after a reduction in hours that causesan employee to lose health benefits.Next, the plan administrator must provide notice to individual employees of their right to elect COBRA coverage within 14 days after the administrator has received notice from the employer.Spouse may elect COBRA coverage on Each qualified beneficiary may independently elect COBRA coverage. A covered employee or the covered employee’s behalf of all other qualified beneficiaries.A parent or legal guardian may elect on behalf of a minor child. Qualified beneficiaries must be given at least 60 days for the election.