Post-employment coverage continuation

[DallasUser]

What is the name of your state? Texas

I was released on June 26, 2002 after a little more than a year with the company. I was enrolled in a PPO, paying the deductible pre-tax. The deductibles were taken from each bi-weekly paycheck, including my last paycheck that was dated June 31, 2002.

On July 3, I called the insurance company to verify that coverage was still in effect - I was told by the rep that it was. On July 5, I refilled my normal prescriptions. I just received a letter of denial on my reimbursement claim by the insurance company stating that the insurance received notification by my former employer that coverage terminated on June 31, 2002.

I was under the impression that Federal law required 30 days minimum contuing coverage after the last date of employment in order for the required COBRA paperwork to be processed. I have been told this by numerous people but I cannot find any information on the web. My former employer is not cooperating and I am being forced to contact the National office, but I am looking for legal ammunition before I take this on.

Thx for your time

 

[cbg]

You and the numerous other people are incorrect. Nothing in Federal law requires insurance to be automatically continued past the last date of employment.

However, that doesn't mean that you are SOL in this situation. Traditionally, coverage is terminated on the last day of employment (depending on the insurance contract, sometimes the last day of the month following the end of employment but that is not required by statute) and COBRA notificiation is sent out. The law requires that if the company is self-administering COBRA, notificiation be sent within 14 days of termination of coverage; if the company is using a third party administrator, they have 44 days to submit COBRA notification. (I have been told by someone I trust, but have not received confirmation, that there has recently been a change in law making the 44 days a standard regardless of the administration.)

Once you receive the notification, you have 60 days to elect COBRA. From the day you make the selection, you have 45 days to send in a check covering all the time from the cancellation of coverage to the present day. Then, coverage is reinstated RETROACTIVE TO THE DAY OF CANCELLATION. Any claims that have been incurred and denied during this period can then be reprocessed for payment.

There are NO CIRCUMSTANCES WHATSOEVER in which COBRA is NOT retroactive to the cancellation date.

 

[evileyes]

cbg

are you saying that you have at least 60 days to choose wether you want cobra or not? i have been triing to be put on my husbands ins .(due to lay-off) i got laid off the end of may they told him that we had to wait until open enrollment . but their handbook says that he can add me any time due to lay-off. now they are saying we waited to long (after i found the info. in the hand book and asked them about it) and are saying we have to wait for open enrollment. but now they wont give an open enrollment date. choose his ins. because its a lot cheaper than cobra. we started asking in june about putting me on his ins. and they kept saying only due to marriage or adoption can he add me told them thats not an option its because im unemployed , but the hand book says otherwise.

 

[cbg]

COBRA and getting put on your husband's insurance are not the same thing. I can't tell for sure by your post if you realize that.

Assuming that your company is required by law to offer COBRA (if they had under 20 employees they would not have been required to by Federal law - some states require it anyway and some companies offer it even if they are not required to, but if they had over 20 employees it's mandatory) then when you were laid off you had 60 days from the notification to elect COBRA. It is legal, and common, for them to cancel your coverage until they receive your COBRA election, at which point they would reinstante it retroactively.

However, you almost certainly had only 30 days to join your husband's plan. If his plan is covered under a Section 125 (if his deductions are taken pre-tax or if he has the option of taking them pre-tax it is; if his deductions are taken post-tax and he has no option of doing pre-tax it's not) then your layoff is a qualifying event but you've only got 30 days from the day your coverage is terminated to join. Doesn't matter what the handbook says. If you missed that window then you do indeed have to wait for open enrollment.

If his plan is not under a Section 125 AND if the insurance carrier is agreeable to it then they may, if they wish, have it open ended for you to come on. However, that would be EXTREMELY unusual. Also, if you did not come onto the plan within the 30 day window and if you were not covered for 63 days or more, you would not have HIPAA protection and any pre-existing condition clauses would apply.

If I haven't answered your question please post back.

 

[evileyes]

i had the cobra option but we choose his ins. because it was cheaper. not sure how his ins. works because him & the children are covered by the company they only charge for spouse's coverage. so they show no info. on that part. we asked in june about putting me on and they told us no ,because i wasn't adopted or we weren't just married that we had to wait till open enrollment. i told them that doesn't apply i just lost my job and want to be added to his ins. because its cheaper than cobra. his is $15.00 a week vs. cobra. then they gave him a new handbook 1st part of Sept.and i was reading it and it explained the insurance qualifactions better and i took it up there and ask them about it . they said yes he could have if he would have came up sooner i told them that he had asked and they said i didnt qualify because of adoption and or marriage clause . now alls they will tell us is they will let us know when open enrollment is at first it was Dec. now they are claiming they don't have a date yet.

 

[cbg]

It's unfortunate that the first person you talked to was unaware that your losing a job is also a qualifying event, but I think it is highly unlikely that you can force them to add you now before the next open enrollment. If the plan is covered under Section 125 (and it is FAR more likely that is is, than that it isn't) they legally cannot add you once the initial 30 day window is up. If they initially told you December, the chances are that they are currently in negotiations and it will happen soon.

 

[evileyes]

ok i got his new booklet out dated august 1st 2002 (not sept.1st )and it says . the effective date of this plan was August 1st,1997. And modifications contained herein is August 1,2002. so maybe that is why they didnt get the connection i wanted it because of layoff and not marriage or adoption. beings i just assumed i would be elgible due to layoff . but i know we started asking in june which would have been in the 30 day time frame. just wanted the coverage just in case anyhow.