COBRA notification and Coverage of a New Born...

[CGInquiry]

What is the name of your state?What is the name of your state? New Jersey.
Question: I am trying to help an employee of ours; I am a recuiter for my firm. This particular employee (let's call him SAM) joined our firm Oct 11, 2004. SAM and his family were covered under his previous employers insurance coverage and his wife subsequently had a baby in his last 2 weeks of his employment there. Thus the Baby and related insurance bills should have been covered by his previous health plan. He even attempted to let his HR dept. know about his new addition to his family. When he left his fomer employer right at the time of his childs birth somehow the child was never added to his health insurance coverage and at this time the company will not recognize this. He was still employed when the child was born. What kind of recourse does SAM have? If he was employed and can show dates of birth corresponding to that shouldn't he have recourse at this time? What are the Cobra ramifications? Is the employer required to notify him of his Cobra election opportunities by certified mail? His insurance coverage with our firm began on Novemebr 1, 2004. Please let me know what kind of recourse he may have to seek the proper coverage for his child and the incurred costs; this is greatly appreciated......Thank you.

 

[Beth3]

There seem to be two separate issues here:

1) Whether Sam notified his employer of the newborn; and

2) COBRA notification.

The key phrase you shared is "He even attempted to let his HR dept. know about his new addition to his family." So did he or didn't he inform them? I can attempt to take a walk this afternoon but that doesn't mean I actually made it out the door.

Yes, his ex-employer needs to send Sam COBRA notification if the company has 20 or more employees. The company has 14 days from the date Sam's coverage with theme ends to do so if they're using an outside administrator; 44 days if they're self-administering COBRA. COBRA notice does not have to be sent certified mail but many companies choose to do so so that they have proof the notice was sent.

 

[CGInquiry]

Beth3: Clarification on notifying HR

First off, thank you for your response.
As to SAM's notifying his past employer of his new born: The company headquarters is located in Atlant,GA -that's where HR is. SAM lives and worked in NJ/NYC. He in turn called several tims and left several voicemails notifying them of his new born and coverage. I am not sure if that is sufficient or not; obviously it would be nice to have a certified letter stating the new born and request for coverage.

Since we are some 6 months down the line is there some kind of recourse based on him being employed and having a child while being employed? If his wife is covered by the plan for the birth isn't the child just an extension of her at the initial birth stage?

Thanks for your insight.

 

[Beth3]

If he left several voicemails, that should satisfy the requirement to add his newborn for coverage. If the employer is denying that he ever contacted them, then he should file a complaint with the federal Department of Labor.

Since we are some 6 months down the line is there some kind of recourse based on him being employed and having a child while being employed? If his wife is covered by the plan for the birth isn't the child just an extension of her at the initial birth stage? The answers to these questions depends upon the terms of the health plan. In some instances, formal notification isn't required at all if the employee already has family coverage. In others, the child is covered for 31 days following the birth regardless of whether the employee notified the employer. In yet others, the child is not covered unless the employee notifies the employer within "X" amount of time.

The bottom line is that just because his wife was covered does not mean the baby is, especially if the employee only had an "employee + spouse" insurance plan, in which case he would have needed to change to the "family" plan.