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Member's COBRA FAQs

Am I entitled to yearly open enrollments?

Yes, COBRA participants have the same rights as all active employees while they are enrolled in COBRA continuation coverage.

How long am I entitled to stay on COBRA if I become disabled and at what point do I notify BenefitHelp Solutions?

If you, or a dependent who is a qualified beneficiary, is determined by Social Security to have been disabled at any time during the first 60 days of COBRA coverage, you and your dependents will be eligible to extend coverage for 11 months. The law specifies that you must provide a copy of the disability determination within 60 days after the date of the Social Security determination and before the end of the original 18-month period that applies to the qualifying event. However, some employers have elected to extend the 60 days time period for submitting the disability extension. Contact BenefitHelp Solutions if you have questions regarding this provision.

The COBRA premiums during an 11-month disability extension are increased to 150% of the regular premium rate.

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When I send in my COBRA enrollment form, am I required to send in the first month's premium?

No. You have 45 days, from the date of election, to make your first premium payment. However, your insurance carrier may not update your eligibility until full payment has been received through the current month.

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If I have other Health Insurance do I still qualify for COBRA continuation?

If you had other group coverage before electing COBRA you have the right to continue both coverages.

Once you elect COBRA coverage and then obtain other insurance your COBRA coverage will terminate on the effective date of your new coverage unless your new coverage has a waiting period for a pre-existing condition.

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Can I add my newborn to my COBRA coverage? How long do I have to notify BenefitHelp Solutions?

You have 60-days to notify BenefitHelp Solutions of a Qualified Status change, however your health plan may require notification within the first 31 days of birth or adoption. Contact BenefitHelp Solutions to find out if your former employer's health plan has a more restrictive timeframe.

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What happens if I move out of the service area of my HMO?

If your former employer offers an insurance option other than HMO, you are eligible to switch to the other plan due to your move.

If your former employer offers only an HMO to active employees and you now reside outside the HMO service area, you may still sign up for the HMO plan, even if it is of limited value.

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Is there a grace period for monthly premium payments?

Yes, you have a 30 day grace period to pay your COBRA premiums, but your insurance carrier may suspend claims payments if your premium is not paid by the first of the month.

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What happens to my COBRA coverage if I become Medicare eligible?

After the date of your COBRA election, your COBRA insurance will terminate on the first day of the month you become entitled to Medicare. If you become entitled to Medicare prior to turning 65 years old, you may elect COBRA.

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If I become Medicare eligible during my 18 months of COBRA coverage, can my dependents still continue on COBRA coverage?

Yes, if your dependents are qualified beneficiaries their COBRA coverage may be extended. The length of continued COBRA coverage is determined by the individual circumstances.

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Is Medicare primary under COBRA? Will there be out of pocket expenses if I do not have both Part A and B of Medicare?

Medicare before and after COBRA coverage begins:

Qualified beneficiaries who are entitled to elect COBRA may do so even if they have other group health plan coverage or are entitled to Medicare benefits on or before the date on which COBRA is elected. Medicare becomes the primary payer for an age-based or disability-based Medicare beneficiary who also has COBRA coverage.

If Medicare entitlement is based on ESRD, then Medicare is the secondary payer for the first 30 months of the Medicare entitlement.

Carriers may assume enrollment in Medicare and estimate claims as if Medicare is the primary payer. This means you may be asked to pay out of pocket the amount that Medicare Part B would have paid. Generally, this is 80% of your medical expenses.

If you haven’t enrolled in Medicare Part B and are eligible, contact the Social Security Administration to discuss your options.

A qualified beneficiary’s COBRA coverage will terminate automatically if, after electing COBRA, he or she becomes entitled to Medicare benefits or becomes covered under other group health plan coverage.

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