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  1. #1
    Indianaflash is offline Junior Member
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    Scottsburg,In
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    Question Dual Coverage -COBRA+Other Ins, "This will be a real challenge!"

    What is the name of your state? Indiana

    Even the insurance companies don't seem to be able to figure out deductibles, co-pays, Max O.O.P.'s, and -at this point- maybe which is primary or secondary coverage. I need advice on how it technically/legally should work.
    Due to unusual circumstances, I had COBRA & another medical Insurance during the 4th Qtr of 2007. (COBRA election reasons and circumstances provided as needed)
    Insurance #1 was a HDHP and effective from 4/15/07 through 10/15/07 and the COBRA coverage that I elected (and paid for) through 12/31/07. She did not elect the COBRA coverageDetails: I was secondary/Spouse insured on my wife's (family) policy at her work.
    Deductible 3000, Max OOP 6000, most Co-pays at 20%. We had met the annual max OOP and all (covered) claims were being paid at 100%.
    My wife (primary insured) changed jobs but the new (family) HDHP Insurance #2 would not be effective until 10/28/07. The new HDHP (#2) was paid 100% by employer so she elected family coverage for the remaider of the year because:
    1) They also contributed some to our HSA.
    2) WE could get family coverage without pre-existing conditions under HIPPA.

    Insurance #2 HDHP effective 10/28/07 thru 12/31/07
    Individual/family deductibe 4000, Max individaul OOP 4500, Max family OOP 8000. (Plan was written incorrectly, but enforced - Changed for 2008 with no individual Max OOP!). I was secondary/spouse on this policy also. My wife started off having met max OOP for year (unusual circumstances) and I started off paying only co-pays.

    I (only) elected COBRA coverage in November with insurance #1 after it was confirmed that we had family coverage with insurance #2. The COBRA (continuation) coverage effective date with Ins #1 was 10/16/07. (no lapse in coverage (for me))
    Finally in Late Dec. my COBRA coverage with Ins #1 was activated and started paying claims back to 10/16/07 but they assigned me a new Account# ,made me Primary, and started me at zero, i.e., I had to pay 1500 deductible (now a single plan) and I then paid 20%co-pay till years end. I was told by Insurance #1 (in October) that deductibles and Co-pays and max OOP accumulated before COBRA election would be carried into the COBRA election period, but they did not.(they are researching that!) I believe that they should have paid at 100%.Should they?
    And what will Ins#2 pay(when filed) if COBRA ins#1 does not have to pay at 100%?

    TOLD YOU THIS WOULD BE A CHALLENGE!What is the name of your state?
  2. #2
    ecmst12 is offline Senior Member
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    Technically COBRA coverage is usually a brand new policy issued under the same terms as the old, but being paid for by the insured instead of the employer. If you were told originally that your deductible and coinsurance limits would carry over, have you contacted customer service to find out why this is not happening? I believe the OOP amounts that you have paid SHOULD carry over, but you have confused the heck out of their computers by switching from family coverage to just you being covered, when you were not even the primary insured person originally. I didn't even think that was POSSIBLE.

    Normally, the insurance through the active employer is primary over COBRA. However it is not YOUR employer that it is through, so it may be that your Cobra coverage will be primary since you are the policy owner of that policy and a dependent on the active policy. We can see if CBG can offer an opinion there but the best thing to do would be make sure both policies have all the correct info and let them figure out who pays first.
  3. #3
    Indianaflash is offline Junior Member
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    Scottsburg,In
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    Thanks ecmst12 for reply
    You said:
    Technically COBRA coverage is usually a brand new policy issued under the same terms as the old, but being paid for by the insured instead of the employer. If you were told originally that your deductible and coinsurance limits would carry over, have you contacted customer service to find out why this is not happening? I believe the OOP amounts that you have paid SHOULD carry over, ...
    I was told by The HR Dept of the former employer, by that companies "COBRA implementation" contractor, and by contact with the insurance companies member service line (2 times) that the accumulated deductibles and co-pays should carry forward. The insurance co has a specialists researching that. However, I did not contact them until late December because the account was not activated until then and I was unaware that the oop's had not be carried forward.

    but you have confused the heck out of their computers by switching from family coverage to just you being covered, when you were not even the primary insured person originally. I didn't even think that was POSSIBLE.
    The US DOL website defines Cobra entitlement, in part, as a individual ...who is either an employee, the employee's spouse....
    While my situation may be unusal and has certainely confused their computers, it would seem that they would be required to accomodate my COBRA coverage.
    In searching the forum prior to my post, I found your replies, as well as CBG's, very helpful. Thanks again
  4. #4
    lkc15507 is offline Member
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    Indiana, I am concerned with your eligibility for #1’s continuation coverage at all. Not that it isn’t possible because it is, but because it would indeed be unusual. Most GHP’s that I have encountered provide for termination of COBRA when the participant becomes covered by a similar plan. In my opinion, #2 is a similar plan and I would be surprised that #1 would not opt to terminate COBRA once you are covered by #2. The plan summary for #1 should describe when they terminate COBRA. Health plans may be MORE generous than required by law, but not less. So, it is possible that #1 would allow you to continue coverage after your effective date with #2, but I would find that very unusual. You mention that you elected COBRA with #1 after becoming effective with #2. Did #1 know you had enrolled in #2? I suspect not. When you elect COBRA in #1 does not matter if #1 expressly states in the plan summary that coverage will terminate when effective in another similar plan. (That rule would/could be applicable in Medicare eligibility situations.) You state that you were the dependant covered on #1 and that you are dependant covered on #2. Again, this to me indicates a similar plan. Had you been the employee covered on #1, I would not question your ability to elect #1 continuation. However, the situation you describe actually provides you with dual coverage that you did not previously have. Although you are right in that finding a published answer to that exact situation is challenging, I don’t believe that COBRA can be interpreted that way. IE, I believe that IF you are eligible for #1 continuation, it must be stated in the provisions of their plan specifically. COBRA provides for continuation of coverage when that coverage would otherwise be lost. I’m not questioning eligibility between loss of #1 and effective date of #2, but I do question your eligibility for #1 after effective in #2 since being enrolled in #2 restores you to your previous state. You also mention pre-existing conditions. It is possible depending on the pre-x provisions of both plans, that #2 could have a stricter limitation that would require #1 to extend COBRA. That could also be found in the plan summaries. In a nutshell, I suspect the lack of payments from #1 has something to do with finding out about #2 and questions of your eligibility. From your post, I suspect that you are making some assumptions that could be incorrect. If not, I apologize. But, for your sake, I recommend that you call #1 immediately to make sure they know about #2 and determine #1’s provisions for continuing coverage when covered by a similar plan. Lastly, IF #1 does continue your coverage, I am reasonably certain that #2 (active coverage) will be primary. As to how #1 coordinates with #2, that will also be found in their plan summary. But, if they do continue your coverage, your #1 OOPs should indeed roll to the COBRA continuation. Since you were at 100% with #1 they will likely pick up all of #2’s OOPs as long as the services are eligible with #1. lkc15507

    PS, Indiana, I am making a few assumptions myself. I am assuming from your last paragraph that #1 paid as the primary payer when they began paying in Dec. That makes me even more concerned that #1 is not aware of #2. It is completely normal for a dependant that solely elects COBRA to be reassigned as the primary insured / participant. (Like ecmst12 says, there is bound to be some "computer" confusion here. When you solely elected COBRA, your personal ID vs. your spouse would be used. IE, your previous dependant status may now be 'invisible'.) However, that would not change the order of coordination, ie primary Payer vs. secondary Payer. All of this continues to make me very concerned that #1 does not know about #2 and that you (and/or your providers) could find yourself being asked to reimburse #1 for payments made.
    Last edited by lkc15507; 01-10-2008 at 07:07 PM. Reason: typo
  5. #5
    Indianaflash is offline Junior Member
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    Great Discussion and questions lkc15507! I will do a couple of posts to discuss your comments and questions.
    I had minor surgery just before the regular coverage of Insurance #1 was to end on 10/15/07 and that has since been paid for 100%. I had some followp medical and Rx bills in the interm before insurance #2 became effective. So I was waiting to find out how much our Cobra coverage would cost us for the 2 week gap. (I had no idea on the cost per month and could not get that information until the "Official COBRA election package" arrived --in November) I was prepared to retroactiely use the COBRA coverage if the cost was less than just paying the bills and I assumed that the premiums would be so high that I would not want to continue the coverage. As stated in my original post, my wife signed me up as a spouse/dependent on insurance #2 for several good reasons; Employer paid for 100%, no pre-existing condition restrictions at that signup-but could be latter, and employer #2 contributed more funds to the HSA for a family plan. Seemed like a no brainer!
    But then in early November, I became concerned that if I (or we) signed up for COBRA -even for 2 weeks or a month - that it might cancel or otherwise affect the new coverage #2. [for some of the reasons that you brought up- but the other way around]. I started searcing the Internet and forums for dual coverage that included COBRA. That's when I found this little gem; "Supreme Court Rules in COBRA Case Involving Dual Coverage". "In Geissal v. Moore Medical Corp , the Supreme Court ruled that employers must provide COBRA continuation coverage to individuals who have other health plan coverage before the date of their COBRA election. " The court made the distinction between the "date of election" and "effective date" of when COBRA coverage retroactively started.
    "The Supreme Court acknowledged that its ruling will allow individuals who obtain coverage under a group health plan (as an employee or otherwise) between the date of the qualifying event and the COBRA election to elect continued coverage"
    This case was brought to the Supreme Court by an individual who's COBRA coverage had been terminated because he also had other insurance (that he had before COBRA election).
    Hopefully, this ruling will address the concerns you raised;
    you said
    "Had you been the employee covered on #1, I would not question your ability to elect #1 continuation" and "...I believe that IF you are elgible for #1 continuation, it must be stated in the provisions of their plan specifically." and "Heath plans may be more generous than required by LAW (my emphasis), but not less."

    You also brought up good points about plan summaries and notifying Ins #1.
    In another post, I want discuss trying to view the plan summaries and my many attempts to not only notify Ins#1 of my dual coverage, but simply find out what was going on and how the dual coverage would work. (but I didn't even 'exist' in their world until I was put into the computer on Dec 22nd, NEARLY THREE MONTHS AFTER THE QUALIFYING EVENT).

    thanks lkc15507

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