COBRA Cindy K o e ne ma nn-Wa rre n, E sq . L ynn, L ynn, Bla c - PowerPoint PPT Presentation

COBRA Cindy K o e ne ma nn-Wa rre n, E sq . L ynn, L ynn, Bla c kma n & Ma nitsky, P.C. VSHRP Me e ting – June 15, 2017, upda te d Ja nua ry18, 2018

2 DI SCL AI ME RS/ CAVE AT S T his pre se nta tio n do e s no t c o nstitute le g a l a dvic e . T he la ws a nd le g a l re q uire me nts c o nc e rning the se ma tte rs a re c o mple x a nd spe c ific issue s sho uld b e a ddre sse d a nd a na lyze d o n a c a se -b y-c a se b a sis in dire c t c o nsulta tio n with sc ho o l distric t le g a l c o unse l.

3 DI SCL AI ME RS/ CAVE AT S T his is no t a c o mpre he nsive tra ining o n COBRA. T he fo c us is o n imple me nta tio n o f COBRA in a sc ho o l se tting . T he re a re o the r rule s tha t ma y a pply in o the r e mplo ye r se tting s. T ho se a re no t c o ve re d he re .

4 WHAT I S COBRA? • Co nso lida te d Omnib us Budg e t Re c o nc ilia tio n Ac t • Re q uire s g ro up he a lth pla ns to o ffe r c o ntinua tio n c o ve ra g e to c o ve re d e mplo ye e s, fo rme r e mplo ye e s, spo use s, fo rme r spo use s a nd de pe nde nt c hildre n • Applie s to pla ns spo nso re d b y sta te a nd lo c a l g o ve rnme nts • I f c o ntinua tio n o f c o ve ra g e is e le c te d, sa me rig hts a nd pla ns a s simila rly situa te d individua ls no t re c e iving c o ntinua tio n o f c o ve ra g e – inc lude s o pe n e nro llme nt, b irth o f a c hild, e tc . • L o ss o f c o ve ra g e ma y trig g e r spe c ia l e nro llme nt rig hts.

5 WHAT I S A HE AL T H PL AN UNDE R COBRA? • De finitio n o f He a lth Pla n: • Any a rra ng e me nt tha t a n e mplo ye r e sta b lishe s o r ma inta ins to pro vide e mplo ye e s o r the ir fa milie s with me dic a l c a re , whe the r it is pro vide d thro ug h insura nc e , b y a he a lth ma inte na nc e o rg a niza tio n, o ut o f the e mplo ye r’ s a sse ts, o r thro ug h a ny o the r me a ns. T his inc lude s a He a lth Re imb urse me nt Arra ng e me nt (HRA). • Me dic a l c a re inc lude s: Inpa tie nt a nd o utpa tie nt ho spita l c a re • Physic ia n c a re • Surg e ry a nd o the r ma jo r me d ic a l b e ne fits • Pre sc riptio n d rug s • De nta l a nd visio n c a re • • Do e s no t inc lude : L ife insura nc e • Disa b ility Insura nc e •

6 QUAL I F I E D BE NE F I CI ARI E S Qua lifie d Be ne fic ia ry is: • An individua l who wa s c o ve re d b y a g ro up he a lth pla n o n the da y b e fo re a q ua lifying e ve nt o c c urre d AND • Who is a n e mplo ye e , the e mplo ye e ’ s spo use o r fo rme r spo use , o r the e mplo ye e ’ s de pe nde nt c hild.

7 QUAL I F YI NG E VE NT S A Qua lifying E ve nt is the e ve nt tha t c a use s a n individua l to lo se g ro up he a lth c o ve ra g e Qua lifying E ve nts fo r E mplo ye e s: • T e rmina tio n o f e mplo yme nt fo r a ny re a so n o the r tha n g ro ss misc o nduc t OR • Re duc tio n in the c o ve re d e mplo ye e ’ s ho urs o f e mplo yme nt

8 QUAL I F YI NG E VE NT S A Qua lifying E ve nts fo r Spo use o r De pe nde nt Child: • T e rmina tio n o f c o ve re d e mplo ye e ’ s e mplo yme nt fo r a ny re a so n o the r tha n g ro ss misc o nduc t • Re duc tio n in the c o ve re d e mplo ye e ’ s ho urs o f e mplo yme nt • Co ve re d e mplo ye e b e c o me s e ntitle d to Me dic a re • Divo rc e o r le g a l se pa ra tio n o f the spo use fro m the c o ve re d e mplo ye e • De a th o f the c o ve re d e mplo ye e • L o ss o f de pe nde nt c hild sta tus unde r pla n rule s (Ag e 26)

9 NOT I CE S AND PROCE DURE S • BDD (Be ne fit De sc riptio n Do c ume nt)/ COC (Ce rtific a te o f Co ve ra g e ) a nd No tic e s must inc lude info rma tio n a b o ut: • Na me o f pla n • Addre ss/ te le pho ne c o nta c t info rma tio n fo r Pla n Administra to r • No tific a tio n re q uire me nts (who , wha t, ho w, whe n) • I mpo rta nc e o f pro viding c urre nt a ddre sse s fo r a ll q ua lifie d b e ne fic ia rie s • Othe r info rma tio n spe c ific to the type o f no tic e (o utline d la te r in pre se nta tio n) Yo u a re the Pla n! Unle ss yo u use a T PA fo r COBRA, the n yo u a re b o th the Pla n!

10 COBRA NOT I CE RE QUI RE ME NT S • Be ne fit De sc riptio n Do c ume nt (BDD/ COC) • Othe r No tic e s: • COBRA Ge ne ra l No tic e • COBRA Qua lifying E ve nt No tic e • CORBA E le c tio n No tic e • COBRA No tic e o f E a rly T e rmina tio n o f Co ntinua tio n Co ve ra g e • COBRA No tic e o f Una va ila b ility o f Co ntinua tio n o f Co ve ra g e (I ne lig ib ility)

11 COBRA GE NE RAL NOT I CE • COBRA Ge ne ra l No tic e • Ha s to b e pro vide d within first 90 da ys o f c o ve ra g e to the e mploye e and spouse c o ve re d unde r the pla n • Ca n b e inc lude d with the BDD/ COC • Use o f the Mo de l Ge ne ra l No tic e is c o nside re d g o o d fa ith c o mplia nc e with g e ne ra l no tic e c o nte nt re q uire me nts • Ge ne ra l No tic e o f COBRA Rig hts must c o nta in: A g e ne ra l de sc riptio n o f the c o ntinua tio n c o ve ra g e pro vide d • unde r the pla n An e xpla na tio n o f wha t q ua lifie d b e ne fic ia rie s must do to • no tify the pla n o f q ua lifying e ve nts o r disa b ilitie s A sta te me nt tha t the g e ne ra l no tic e do e s no t fully de sc rib e • COBRA o r the pla n a nd mo re info rma tio n is a va ila b le fro m the pla n a dministra to r a nd the BDD/ COC And no tic e c o nte nts o utline d o n prio r slide •

12 COBRA QUAL I F YI NG E VE NT / E L E CT I ON NOT I CE • COBRA Qua lifying E ve nt No tic e • T he e mplo ye r must no tify the pla n if the q ua lifying e ve nt is: T e rmina tio n o r re duc tio n in ho urs o f e mplo yme nt o f c o ve re d • e mplo ye e De a th o f the c o ve re d e mplo ye e • Co ve re d e mplo ye e ’ s b e c o ming e ntitle d to Me dic a re • Must no tify the pla n within 30 da ys a fte r the e ve nt o c c urs • • T his trig g e rs the E le c tio n No tic e Re q uire me nts

13 COBRA QUAL I F YI NG E VE NT / E L E CT I ON NOT I CE • COBRA Qua lifying E ve nt No tic e • T he c o ve re d e mplo ye e o r q ua lifie d b e ne fic ia rie s must no tify the pla n if the q ua lifying e ve nt is: Divo rc e • L e g a l Se pa ra tio n • Child’ s lo ss o f de pe nde nt sta tus unde r the pla n • • T his trig g e rs the E le c tio n No tic e Re q uire me nts

14 COBRA E L E CT I ON NOT I CE • CORBA E le c tio n No tic e • Afte r re c e iving no tic e o f q ua lifying e ve nt, the pla n must pro vide a n e le c tio n no tic e , whic h de sc rib e s rig hts to c o ntinua tio n o f c o ve ra g e a nd ho w to ma ke a n e le c tio n • Must b e pro vide d within 14 da ys o f no tic e o f the q ua lifying e ve nt • Use o f the mo de l no tic e will b e c o nside re d g o o d fa ith c o mplia nc e with the e le c tio n no tic e c o nte nt re q uire me nts o f COBRA, if c o mple te ly pro pe rly

15 COBRA E L E CT I ON NOT I CE • CORBA E le c tio n No tic e No tic e must inc lude : No tic e c o nte nts liste d pre vio usly • Id e ntific a tio n o f q ua lifying e ve nt • Id e ntific a tio n o f the q ua lifie d b e ne fic ia rie s b y na me o r sta tus • An e xpla na tio n o f the q ua lifie d b e ne fic ia rie s rig hts to e le c t • c o ntinua tio n c o ve ra g e T he d a te c o ve ra g e will te rmina te / te rmina te d if no t c o ntinua tio n • c o ve ra g e is no t e le c te d Ho w to e le c t c o ntinua tio n c o ve ra g e • Wha t will ha ppe n if c o ntinua tio n c o ve ra g e is no t e le c te d o r is • wa ive d Wha t c o ntinua tio n c o ve ra g e is a va ila b le , fo r ho w lo ng a nd ho w it • c a n b e e xte nd e d fo r d isa b ility o r se c o nd q ua lifying e ve nts Ho w c o ntinua tio n mig ht te rmina te e a rly • Pre mium pa yme nt re q uire me nts, inc lud ing d ue d a te s a nd g ra c e • pe rio d s Sta te me nt tha t the e le c tio n no tic e d o e s no t fully d e sc rib e COBRA • o r the pla n a nd mo re info rma tio n is a va ila b le fro m pla n a d ministra to r a nd the BDD/ COC

16 E L E CT I ON PROCE DURE S • At a minimum must g ive a t le a st 60 da ys to e le c t c o ntinua tio n c o ve ra g e • 60 da ys fro m the la te r o f: • Da te the q ua lifying e ve nt o c c urs • Da te o n whic h the q ua lifie d b e ne fic ia ry lo se s/ wo uld lo se c o ve ra g e a s a re sult o f the q ua lifying e ve nt • Da te o n whic h the q ua lifie d b e ne fic ia ry is info rme d o f no tic e re spo nsib ilitie s a nd pro c e dure s (Ge ne ra l No tic e / BDD/ COC) • I f o ne pe rso n g ive s no tic e , the no tic e c o ve rs a ll q ua lifie d b e ne fic ia rie s a ffe c te d b y the e ve nt • E a c h q ua lifie d b e ne fic ia ry ha s a n inde pe nde nt rig ht to e le c t c o ntinua tio n c o ve ra g e • E ve n if wa ive d, c a n c ha ng e mind until e nd o f e le c tio n pe rio d; Co ve ra g e c a n b e g in o n da te wa ive r wa s re vo ke d