If continuation coverage is terminated prematurely, the plan must provide early termination to the eligible beneficiary. (See «Election Notices and Procedures» earlier in this brochure.) This brochure summarizes COBRA continuation coverage and explains the rules that apply to group health insurance plans. It is designed to help employers sponsor group health plans comply with this important federal law. Answer: Check your health insurance to further determine what options are available at the end of coverage. The contract should give you more information about your rights. You should also check with your employer or plan administrator. If an employee or dependent chooses to choose COBRA instead of a special registration when group health insurance is lost, the employee or dependant has another option to request a special registration once COBRA is exhausted. To take advantage of COBRA coverage, the person must receive the maximum COBRA coverage available without early termination. To register specifically after COBRA is exhausted, an individual must apply for registration within 30 days of losing COBRA coverage. Answer: In certain circumstances, a person may have the right to continue to receive coverage under the laws of the State of New York. If an insured person loses coverage due to termination (for any reason) or loses membership in the class or classes eligible for coverage under the policy, the insured person has the right to continue to insure for themselves and their eligible dependents, subject to the terms of the group contract and certain other restrictions. Plans have the right to terminate continued coverage if full payment has not been received before the expiration of a grace period. If the amount of a payment made to the plan is incorrect, but is not significantly less than the amount due, the plan must inform the eligible beneficiary of the deficiency and allow a reasonable period of time (for this purpose, 30 days are considered appropriate) to pay the difference.
The plan is not required to send monthly premium notices, but is required to provide notice of early termination if continuation coverage is terminated prematurely due to late payment. In general, the COBRA qualification event must be a termination of employment or a reduction in the periods of employment of the insured employee. Secondly, under Title II or Title XVI of the Social Security Act, the insured employee must be designated as disabled. Third, the person must be disabled at some point in the first 60 days of COBRA continuing insurance, regardless of whether the disability began before or during that period. Fourth, while the disability must begin within the first 60 days of COBRA coverage, the Title II or XVI disposition may be issued at any time during the 18-month COBRA reporting period that began with the eligible event. Finally, the insured employee must usually inform the plan administrator of the disability determination within 60 days of the date of issue of the disability contribution, but no later than the end of the 18-month continuation coverage period applicable to the eligible event. In addition, the extended period of COBRA ends when, under Title II or XVI, it is definitively established that the person is no longer disabled. Answer: An eligible event is one of the following events that would result in the loss of health insurance coverage: (1) the death of the insured employee, (2) the termination (except for serious misconduct) of the employment relationship of an insured employee, (3) a reduction in the period of employment of an insured employee, (4) the divorce or separation of the spouse of an insured employee from the employee`s spouse, (5) an insured employee who is entitled to Medicare benefits, (6) a dependent child who is no longer a dependent child of the employee covered under the terms of the group health plan, and (7) in respect of certain retirees and their dependents, insolvency proceedings of an employer under Title 11 of the United States Code, which begins on or after 1 July 1986. If the eligible event is the termination of employment or the reduction of the employee`s hours of work, and the employee was eligible for Medicare less than 18 months prior to the eligible event, COBRA coverage for the employee`s spouse and dependents may last up to 36 months from the date the employee is eligible for Medicare. For example, if an insured employee is eligible for Medicare 8 months before the end of their employment relationship (termination is the COBRA qualification event), COBRA coverage for their spouse and children would last for 28 months (36 months minus 8 months). For «insured employees», the only eligible event is dismissal (whether the dismissal is voluntary or involuntary), including through retirement or shortening of the period of employment. In this case, COBRA lasts eighteen months.
COBRA requires group health insurance plans to provide ongoing insurance to insured employees, former employees, spouses, former spouses and dependent children if group health insurance would otherwise be lost due to certain specific events. These events include the death of an insured employee, the termination or reduction of an insured employee`s period of employment for reasons other than gross negligence, an insured employee`s right to health insurance, the divorce or legal separation of an insured employee and his or her spouse, and the loss of a child`s maintenance status (and thus coverage) under the plan. COBRA sets out rules on how and when continuation coverage should be offered and provided, how employees and their families can choose continuation coverage, and what circumstances justify terminating continuation coverage. Answer: You must request further reporting in writing within 60 days of the later date: (1) the date of termination; or (2) the date on which the employee is informed of the right to continue by his or her employer or the plan. If a group health care plan decides to terminate continuation coverage prematurely, it must provide the eligible beneficiary with a notice of early termination. The notice must be given as soon as possible after the decision and must describe the date of termination of the coverage, the reason for the termination and the rights that the eligible beneficiary may have under the plan or applicable law to choose another group or individual coverage, such as a right to conversion into an individual policy. If the eligible event is the termination of employment by the employee concerned (for reasons other than serious misconduct) or the reduction of working time, qualified beneficiaries must benefit from a guarantee of continuation of up to 18 months. Although COBRA allows for early termination of the reporting of these events, it is important to remember that it does not require termination. Govern the documents, policies and practices of the employer plan. Eligible events are listed below: the death of the insured employee; the termination of the employment relationship or the shortening of periods of employment by an insured employee; the insured employee who is eligible for medicare; divorce or legal separation from the employee concerned; or a dependent child who is no longer dependent under the generally applicable requirements of the plan. Multi-employer plans are allowed to adopt special rules for COBRA communications. First, a multi-employer plan may set its own uniform timelines for announcing the eligible event or notifying electors.
A multi-employer plan may also choose not to require employers to provide notices of eligible events and instead let the plan administrator determine when an eligible event occurred.