COBRA Coverage Question

[mickeysgal]

My DH's job was eliminated as part of a corporate merger at the end of May. The employer paid for the first two months of medical coverage (June and July of this year). We have to take COBRA coverage from that point on (Aug 1st). During this time, DH started a new job but can't get medical coverage until Sept 15th. We just completed the first step in electing Cobra coverage but didn't have to send in any premium yet. The payment coupons are in the process of being send and the first premium isn't due until end of Sept. (Cobra is retroactive) and will cover dental for June and July and medical for Aug. If we hold off sending in the premium and we get to Sept 15 and take the employer's coverage, will we have to show continuation of coverage since we're talking only a 46 day lapse in medical coverage? Does this affect our insurability by allowing a gap? I'm not sure if I'm explaining this correctly. Of couse, if we need medical between now and Sept 15, we'll go ahead and pay the Cobra, but I'm wondering if there is an allowable way to stretch it to Sept 15 and not cause an insurability gap in coverage.

 

[agotta]

You might want to call what will be your new insurance company. There are different amounts of time that may be allowed for being uninsured...I know ours is 63 days without a lapse in coverage...Just double check with them the # of days that you could have a lapse in coverage. Otherwise pre-existing conditions may not be covered for a specified period of time.

 

[hlbtimes2]

Most companies just require coverage in the last 90 days. But, I would probably check with the new company just to make sure.

 

[kelleigh1]

It's been a couple years since I worked in the insurance industry, but I used to know COBRA fairly well. And from what I remember, you do not want to have more than a 30 day break in coverage.

HIPAA law provides that you must be allowed continuation of coverage as long as you do not go more than 30 days without.

If you have more than a 30 day window, you could be uncovered for pre-existing conditions (or have a time limit set on pre-ex) or (in some states), you could be denied coverage entirely.


CORRECTION I just looked up the HIPAA law and I was incorrect. The HIPAA law states 63 days break is considered reasonable as another person posted.

 

[kelleigh1]

Here's a link to the HIPAA information if you'd like to see where I'm getting the info.

http://www.dol.gov/ebsa/pdf/consumerhipaa.pdf

I believe it was around Pg. 11 that I found the correct into.

 

[manchurianbrownbear]

I think your question has already been answered, but I agree that:

1. As long as your lapse in coverage is not more than 63 days, you still have "continuous coverage".

2. You have 60 days to decide whether you want to take COBRA coverage. If you elect to take COBRA coverage on day 59, the coverage is effective retroactively to the day your coverage expired.

So... if your next employer-sponsored health plan becomes effective less than 63 days after your last employer-sponsored plan expires, you're wise to wait and see if you need the COBRA coverage. MANY people pay hundreds of dollars for COBRA coverage that they never use! Even if you have a couple office visits in the gap between the two employer plans, the cost of that care is probably going to be less than the COBRA premiums!

 

[Snoozan]

Yes, it's the 63 days that's important for COBRA coverage. If you have had coverage and you elect new coverage before the end of the 63 days, it'll be considered you've had continuous coverage and should not be considered a late entrant or have to fulfill any elimination period for the new coverage. At least, this is how it works for the medical insurance at the insurance company I work for! I'd contact the new insurance company to verify their coverage. You also want to be sure to get the Proof of Credible Coverage from your prior insurance carrier - That's proof from them with with effective and term dates for their coverage, as well as all the dependents who had coverage. If you haven't received that yet from his old employer - contact the HR department and see if you have to request this yourself from the old insurance company. Some ER's will provide this, others make you request it yourself.

 

[DMickey28]

So if I understand this correctly if you had coverage until June 30th with one company and then coverage with the second company is effective Sept 1 you will fall within the HIPPA 63 day continous coverage guidelines?

 

[Kirk]

Why don't you just get some temporary insurance? That's what I got my daughter for in between the time she dropped off mine and goes onto her own. It was cheap with a high deductable and I have the peace of mind that if there were an accident or something she'll be covered. Here's where I found it:


eHealthInsurance


-

 

[Snoozan]

DMickey28- you have to count EACH day to be sure it doesn't add up to 63 days between coverages. July and August are both long months of 31 days each so I can't recall if they count the last day of the old coverage or the first day of the new coverage. The new insurance company would be able to tell you what day is the last day of the 63 day period.

In the case of the OP, as their gap is only from 8/1 until 9/15/06, as long as they show proof of prior coverage(again, they need to request the Certificate of Credible Coverage from prior insurance), they should be eligible for the new coverage without any waiting period penalties.

 

[golfgal]

When DH switched jobs last year we had a similar situation. In our case it turned out to be 60 days between the end of the one policy and the beginning of the other. We didn't send anything into COBRA because we knew we would not need to pay if we didn't use the coverage. If something major had happened in that timeframe, we would have then sent payment to COBRA and it would have been covered. It is legal to do that after the fact as long as you are in the time constraints.

Hold off making payment to COBRA because if you don't need it, it is a lot of money to spend if you don't need to. In our case it would have been over $2000 for those 2 months of coverage. If one of the kids needed to go to the dr for an ear infection or whatever, we would have just paid the medical costs out of pocket, it would have been a LOT less expensive. If someone needed surgery, we would have paid the COBRA payment.

 

[mickeysgal]

When DH switched jobs last year we had a similar situation. In our case it turned out to be 60 days between the end of the one policy and the beginning of the other. We didn't send anything into COBRA because we knew we would not need to pay if we didn't use the coverage. If something major had happened in that timeframe, we would have then sent payment to COBRA and it would have been covered. It is legal to do that after the fact as long as you are in the time constraints.

This is exactly what we're hoping to do. We had to do the election form and chose dental and medical. The prior employer has picked up the cost of medical for June and July. We have 45 days from the date of the election (mid Aug) to make the payment which will be retroactive. It will be due at the end of Sept. According to the place that is handling the Cobra payment for the company, the first payment will consist of dental for June, dental for July, and dental/medical for August.

The latest twist is since we selected medical and dental, right now, they consider those first two months still in not-completely-paid status since only the medical has been paid. If we don't make the Cobra payment (due to getting the new insurance), we'll terminate Cobra back to the original end of May date (since the first two months aren't completely paid). Therefore, I'll be out of the 63 day range entirely.

I don't mind paying the dental portion to cover June and July, but I have to wonder if they'll apply it as I need it applied. I was thinking of sending in separate checks marked June dental and July dental. I still hope that they'll apply it as such.