Specific Notices regarding the COBRA Law

[the5berks]

What is the name of your state (only U.S. law)? Michigan

Hello,

I took a lay off from an employer due to lack of work. I was never given any specific notice of COBRA availability or unavailability. The COBRA Law was revised on May 26, 2004 that provides that the employee be notified either way, either my specific rights to COBRA continuation of benefits (original law in 1986) or notice of unavailability of continuation of coverage (added specific notice to the law in 2004). The first notice I received that my insurance was dropped was from the insurance company 60 days later (Certification of Creditable Coverage notice). No other notices, verbal or written were ever made from anyone. When I called the employer, he claims he has fewer than 20 people enrolled in the group health care plan. The employer in this case is a contract house, so I had no idea until after the fact that this was the situation. Does not an individual have the right, under COBRA Law to be informed that their health insurance is being dropped per the specific notice requirements under the law?

Thank you.

[TIMMAAYY]

Under 20 employees, an employer is under no obligation to offer COBRA.

From this source: [url=http://www.cobrahealth.com/thelaw.htm]The Consolidated Omnibus Budget Reconciliation Act[/url]

Group health plans for employers with 20 or more employees on more than 50 percent of the working days in the previous calendar year are subject to COBRA. The term "employees" includes all full-time and part-time employees, as well as self-employed individuals. For this purpose, the term employees also includes agents, independent contractors and directors, but only if they are eligible to participate in a group health plan.

Do you have any medical conditions that require medication or treatment regularly? Are you going to be employed anytime soon? When was the last date of your coverage?

[the5berks]

I understand my former employer has no obligation to offer COBRA---now. I had no idea about that at the time because it was a contract house. My question is one of notice. I was given no notice that it would NOT be offered COBRA. My coverage ended on July 31st. And yes, I have a condition that needs regular treatment and it is extremely expensive. I had this treatment on Aug 5th and now I am stuck with a $7,000 bill, I have no insurance, no job and unemployment is running out in 3 weeks I need this treatment every 12 weeks. I doubt I will have a job soon. I have been out of work all this year except for this 9 week contract job.

[TIMMAAYY]

You can always try negotiating with your doctor. Explain your situation and see what happens. Most people don't realize they potentially have this as an option. With any luck you can reach some sort of agreement until you find employment and obtain an insurance plan again.

There is no requirement of notice, unless they fall into COBRA law, which they don't.

Actually, after doing a little reading, it looks like you might be eligible for "conversion", because your employer is under 20 employees. Read up here:

[url=http://www.michigan.gov/dleg/0,1607,7-154-10555_12902_35510_35540---,00.html]DLEG - Leaving an Employer Group[/url]

From the above link:

Continuation if you are laid off by a Michigan "small" employer, less than 20 employees.

You have the right to a conversion policy with the small employers group insurer or HMO.
You can apply for a policy with Blue Cross Blue Shield of Michigan.
You can apply for coverage with an HMO that services your area during the HMOs open enrollment period.

Looks like you'll have to find out what conversion plans are available and how/when you can enroll.

Good luck.

I'm not sure how Michigan's conversion plans work. Some states it's the same plan as you would have had on COBRA ( same plan you had ). Other states, it's a totally separate plan design.

[the5berks]

Thank you Tim for your replies. With conversion, I suppose it is too late now to expect retro coverage back to August 1st?

Jeff

[TIMMAAYY]

You might not even be eligible for conversion now... the wording is a little off. It says "within 30 days of your group coverage ending or within ??? days of COBRA eligibility ending". I'd check it out, though. Hopefully there is a way to get you in, even if you have to wait for an open enrollment period.

[the5berks]

Hi Tim,

According to the Michigan Department of Labor & Economic Growth, I have a right to a conversion policy for continuation of insurance due to a lay off by a Michigan small employer (less than 20 employees). According to my Group Insurance Certificate issued by my insurance company, there are no provisions outlining these rights. Furthermore, my insurance company has never notified me in any form, verbal or written, of my rights for conversion of this policy or has communicated an offer for conversion of the group policy to me since the termination date of the group policy. I wrote a grievance letter to them stating these facts and requested them to notify me of my conversion rights under Michigan State Law regarding this issue and to establish this conversion effective August 1, 2008.

Not sure what leg I have to stand on. I know in prior circumstances I have always been sent a letter stating my converstion rights upon termination of insurance. This goes for group life insurance policies as well. I assume these notices are supplied due to Michigan Law, however in searching the net, I am having a hard time finding the law as written to confirm that.

Jeff

[the5berks]

I meant to add, I also found this in the same site you were looking at:

What are my options for group conversion or open enrollment as a HIPAA eligible individual?

In Michigan you must be offered a conversion to an individual policy issued by the same company that issues your employer’s group policy. The group conversion policy must be issued with no pre-existing condition exclusions and cover all members of the family covered under the group plan.


I interpret "you MUST be offered" as an act that the insurance company must provide to me, and in this case, there is never a mention, even in their certificate of insurance provided to me at the beginning of the group policy.

jeff

[TIMMAAYY]

There may be a time limit though, from the day your last coverage ended. Hopefully not, but keep that in mind.