|
State Continuation of Coverage Notice (COBRA)
|
|
Important Information About the Continuation of Coverage Notice In most cases, employees who become ineligible for group coverage are able to continue their group health coverage for a specified time at group rates. This option is required by federal and Missouri state laws. The federal law is known as COBRA. It does not apply to employers with fewer than 20 employees, plans for federal employees or church plans. The Missouri law does not apply to self-insured groups and federal employee groups. The Continuation of Coverage Notice provides detailed information about the requirements for eligibility under both federal and state laws. It also explains for eligible participants their rights and options and the type, cost and duration of coverage available to them under the COntinuation of Coverage provisions. Continuation Coverage May Be Available If Your Eligibility Ends If you become ineligible for coverage through your group, you may be able to continue coverage for a time at group rates. This option is required by federal and Missouri state laws. The federal law is known as COBRA. It does not apply to employers with fewer than 20 employees, plans for federal employees or church plans. Missouri law does not apply to self-insured groups and federal employee groups. If an employer is affected by federal law, its provisions take precedence over state law during the period its provisions are in effect. If an employer is not affected by federal law, the provisions of state law apply. In general, if your employer has fewer than 20 employees, state law applies to you. State law also applies to church groups, regardless of size. Also, certain persons may be eligible for additional Continuation Coverage under Missouri law after they use up their Continuation Coverage allowed under federal law. Continuation Coverage Under Federal Law Under the federal law, covered employees are eligible for continuation of group coverage for up to 18 months in certain cases. They are eligible if they would otherwise lose coverage due to any of the following:
Any covered family members can also continue to be covered. They can continue under the employee's coverage or they can apply for coverage in their own name. If they are eligible due to an employee's termination, layoff or reduced hours, a covered spouse and/or covered unmarried children are only eligible for Continuation Coverage for up to 18 months. However, they are eligible for up to 36 months if they would otherwise lose coverage due to any of the following:
*If, within 18 months after becoming entitled to Medicare, an employee ends employment or has reduced hours, the 36 months of Continuation Coverage for covered family members will begin from the date the employee became entitled to Medicare. In addition, non-Medicare eligible retirees and their dependents can continue group coverage for up to 36 months if the employer declares bankruptcy. Extended Coverage for Disabled Individuals and Their Eligible Family Members In certain cases, a disabled individual can extend Continuation Coverage for 11 months beyond initial 18-month period. The additional 11 months will be available if the individual was disabled when he or she became eligible for Continuation Coverage. It will also be available if he or she becomes disabled at any time during the first 60 days of Continuation Coverage. Eligible family members are also entitled to the 11-month extension. The Social Security Administration must determine disability. Then, this disability determination must be sent to us before the first 18 months of Continuation Coverage ends. Cost People who choose Continuation Coverage can be charged up to 102% if the cost of coverage. For a qualified disabled person and all covered family members who choose to continue coverage beyond the initial 18-month eligibility period, the employer can charge up to 150% of the cost of coverage. Payment must be made from the date coverage would otherwise have ended. Coverage An eligible person may continue only hospital and medical/surgical coverage. Or, the person may continue these benefits, plus additional benefits available to others in the group (such as dental or vision benefits). Life and disability coverages cannot be continued. Independent Choice Each eligible person is entitled to make an independent choice in regard to Continuation Coverage. For example, an employee might choose both core and noncore benefits. But a spouse or child might choose only core benefits. Or the employee might choose not to take Continuation Coverage. But a spouse or child could still continue coverage for up to 18 months. Second Qualifying Event People who take Continuation Coverage can have another "qualifying event" that may allow them to extend their coverage up to a total of 36 months. The second qualifying event must occur while the person has Continuation Coverage. For example, if an employee is laid off, the employee, covered spouse and children may continue coverage for up to 18 months. Assume that they take the coverage, and seven months later, the employee dies. The surviving spouse and children would then be entitled to 36 months of Continuation Coverage. However, the seven months during which they already had coverage would be included in the 36 months. Rights People who choose Continuation Coverage have the same rights as other group members. For example, continuation participants can add dependents or change coverage type, as other enrollees can. Notification The employee or a family member is responsible for notifying the plan administrator within 60 days after a divorce, legal separation or a child losing eligibility. The plan administrator must notify eligible people of their right to continue coverage by providing a Continuation of Coverage Notice and a Continuation of Coverage Form. This will allow them to indicate whether they want continued coverage. 60 Days to Decide A group participant must decide whether to continue coverage within 60 days after coverage terminates or within 60 days after being notified of eligibility, whichever is later. If a participant does not respond within 60 days, he or she will not be eligible for Continuation Coverage. If Continuation Coverage is elected, the person has 45 days in which to pay the initial premium. Termination In certain cases, Continuation Coverage will stop before the time period specified earlier. It will stop if any one of the following situations is true:
However, if the person becomes covered under another group health plan, Continuation Coverage would not have to terminate early if the new plan excludes or limits coverage of any preexisting conditions for that person. The person's Continuation Coverage for all services, (not just services related to any preexisting conditions) would not end until the original eligibility period ends or until the preexisting conditions limitation or exclusion ends, whichever occurs first. Note: Certain persons may be eligible for additional Continuation Coverage under Missouri law. (see next.) Continuation Coverage Under Missouri law for Groups of 20 or More Affected By Federal Law Additional Continuation Coverage is available under Missouri law for a covered spouse and children of an employee whose group sponsor is affected by federal Continuation Coverage and has 20 or more employees. Who is eligible Additional Continuation Coverage may be available for dependent spouses and children if the employee's spouse will be at least 55 years of age when their federal Continuation Coverage ends. Also, during the time the spouse was on federal Continuation Coverage, the employee must have died or the employee and spouse must have divorced or legally separated. Coverage does not have to be provided for any family member who has not already covered at the time federal Continuation Coverage ended. Cost For this additional coverage provided under Missouri law, the person may be charged up to 125% of the cost of coverage. Payment must be made from the date coverage would have ended. Coverage Only hospital and medical/surgical benefits must be offered to continuation participants. The law does not require that optional benefits, such as dental or vision benefits, be offered. Notification The plan administrator must receive notice within 30 days of the employee's death, within 60 days of the employee's divorce or legal separation or before the 36 months of federal Continuation Coverage ends. The notice must include the mailing address of the employee's spouse. Then, within 14 days, the plan administrator must notify the spouse of the right to Continuation Coverage under Missouri law. The spouse has 60 days from the date the notice and continuation of coverage election from were mailed to return the completed form. Termination The spouse can continue coverage until one of the following occurs:
An enrolled dependent child can continue coverage under the spouse's program until one of the following occurs:
Continuation Coverage under Missouri Law for Groups Not Affected by Federal Law If group members are not eligible for Continuation Coverage under federal law, Continuation Coverage is available under Missouri law for up to nine months. Group coverage can be continued by the employee or by the employee's widow(er) or divorced spouse. Covered family members may be included on the membership. An eligible person who wants to continue coverage must have been covered under the group program for at least the previous three months and must not be eligible for Medicare or for another group program in which he or she was not already enrolled. Cost People who choose Continuation Coverage can be charged 100% of the cost of coverage for the type of program they had previously. Payment must be made from the date coverage would otherwise have ended. Coverage Only hospital and medical/surgical benefits must be offered to continuation participants. The law does not require that optional benefits offered by the group, such as dental or vision benefits, be offered to continuation participants. Rights Continuation Coverage is available for the employee and a covered spouse and/or children only when the employee's coverage ends due to termination of employment. A covered spouse and children are eligible to continue coverage only if the employee continues coverage, unless the employee and spouse divorce or the employee dies. Continuation participants can add dependents base on the same rules that apply to other group members. Notification Employees are required to notify eligible persons in writing, no later than the date on which coverage would otherwise terminate, that they have the opportunity to continue coverage. People who want to continue coverage must submit their request in writing, along with their first monthly payment, within 31 days of the date coverage would have terminated. Termination If a person chooses this continuation option, Continuation Coverage would stop earlier than the time period specified above if any one of the following situations is true:
|
|
| Awards
& Achievements | Insurance Companies
| Disaster Recovery | New
Madrid Earthquake |