question about COBRA

[Venus21pam]

I have a hypothetical question about the COBRA coverage.
I've done some reading and found out that federal law allows 60 days to decided whether we want COBRA or not.
Now lets say that it is day 50 after the termination of my policy (so I still have 10 days to decide) and I get really sick. I end up being hospitalized for a couple days and the bill is like $10,000.
Can I still enroll in COBRA after the incident (but within the 60 day period of course) and be covered? Or will the insurer decline my coverage then because of the incident??

I would like to hear from someone who's been in a situation like this or knows of someone who did.

Thanks in advance!

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[sdn1977]

I can only tell you from the pharmacy portion of your COBRA policy (almost all - I've NEVER had one that didn't work this way). Once you send in your payment, you'll receive coverage for that month - but the coverage won't be an "online" coverage which you're used to at a pharmacy (immediate adjuducation).

The rejection will state "coverage terminated". This means your coverage is now in a COBRA mode - you have a different ID & group number than you had originally & now you must submit for reimbursement for drugs covered. You must pay full price up front & get reimbursement later. If you make on time payments for the following 18 months, you'll have a new ID & group # & the coverage will be similar as it was prior to your temination.

But, the transiiton will take 2-3 months.

Sorry - I can't help you with medical coverage - that is a differnt part of your plan.

 

[Long Dong]

COBRA is the enemy of GI joe, that's all I have to contribute.

 

[tibor75]

That's a good question.

Here is what little I know. I need COBRA starting July 1 until my new policy kicks in August 1. From what I gather, I can't sign up for COBRA now (or even tell them that I want COBRA).

What they told me was that on July 1, when my current policy expires, that I will be sent an automatic letter asking if I want COBRA coverage. I say yes, and then the coverage is retroactive from July 1.

In part this makes sense, because for many people, you don't have any advance warning that you want COBRA. If you get fired today (for any reason other than gross misconduct), your health insurance is cancelled (if received through your work), but you are still eligible for COBRA coverage. This would also apply if you get coverage through your spouse's work and he/she dies.

 

[Venus21pam]

That's a good question.

Here is what little I know. I need COBRA starting July 1 until my new policy kicks in August 1. From what I gather, I can't sign up for COBRA now (or even tell them that I want COBRA).

What they told me was that on July 1, when my current policy expires, that I will be sent an automatic letter asking if I want COBRA coverage. I say yes, and then the coverage is retroactive from July 1.

In part this makes sense, because for many people, you don't have any advance warning that you want COBRA. If you get fired today (for any reason other than gross misconduct), your health insurance is cancelled (if received through your work), but you are still eligible for COBRA coverage. This would also apply if you get coverage through your spouse's work and he/she dies.

That's right. I found all that info on my COBRA notification and online.
The federal law requires that all participants have a 60 day period after receiving the COBRA enrollment application to decide whether they want to enroll. And after you sing the enrollment paper you still have 45 days to make the first payment. Of course in same cases if you wait all the 60 + 45 days you'll end up paying for 3 months at once, but the coverage should be activated retrospectively.

My only concern would be that if I don't enroll immediately and then become injured/hospitalized would the insurer have a right to decline COBRA coverage even if I was still withing the 60 day window allowing me to enroll and I wanted to enroll after the given injury/hospitalization.

Anyone??

 

[tibor75]

My only concern would be that if I don't enroll immediately and then become injured/hospitalized would the insurer have a right to decline COBRA coverage even if I was still withing the 60 day window allowing me to enroll and I wanted to enroll after the given injury/hospitalization.

Anyone??

I doubt it, because I don't think there is anyway you can enroll "immediately." If you get laid off your job tomorrow, does that mean you get screwed if you get in an accident the next day?"

But I'm sure it's a hassle and involves all amount of red tape, so I'd avoid getting sick if I could.

 

[mshheaddoc]

http://info.insure.com/health/cobra.html
http://www3.georgetown.edu/hr/benefits/cobra.html
http://articles.moneycentral.msn.co...urCOBRArights.aspx?f=25&MSPPError=-2147197912
http://www.cobrahealth.com/thelaw.htm

If you initially waive your COBRA rights and then change your mind within 60 days, beware that any doctor bills you had during that period won't
be covered.

Once notified, the plan administrator then has 14 days to alert you and your family members — in person or by first-class mail — about your right to elect COBRA. The IRS gets tough here: If the plan administrator fails to act, he or she can be held personally liable for a breach of duties. However, the plan administrator must have your correct mailing address. If you move, it is your (or your family's) responsibility to tell the health plan administrator.

You, your spouse, and children have 60 days to decide whether to buy COBRA. This election period is counted from the date your eligibility notification is sent to you or the date that you lost your health coverage, whichever is later. Your COBRA coverage will be retroactive to the date that you lost your benefits (as long as you pay the premium).

During the election period when you have to choose whether to buy COBRA, you might initially decide not to, which means you waive your right to coverage. However, as long as the election period hasn't expired, you can change your mind and revoke your waiver, and COBRA coverage would then start on the day the waiver was revoked. Bear in mind that if you visit a doctor during the period you initially waived COBRA, you will not be reimbursed for that claim even if you later decide to buy COBRA. In this case, COBRA is not retroactive to the date you lost your employer-sponsored plan.

Conversely, even if you enroll in COBRA on the last day that you are eligible, your coverage is retroactive to the date you lost your job, provided you pay all the retroactive premiums.

Looks like as long as you don't decline in the 60 day period leading up to that last 60th day, then you can get retroactive. If you initially decline, but decide to join on the 59th day (which you can do), then you are responsible for the bill.

 

[chimichanga]

I've had firsthand experience...

Tell them that you want the coverage, don't decline.

They'll tell you when the last day you have to pay before they'll drop your COBRA eligibility. Don't pay the premium if you don't have to...If you don't get sick, nothing lost. If you do, make a premium payment, and it's covered retroactive from day 1 of eligibility. HR schooled me on this common game years ago...

As far as showing a gap between coverages, tell the new insurance carrier you were in between jobs, and declined COBRA.

 

[Winged Scapula]

Chimi is correct.

When you leave one position, you will get notification of your COBRA eligiblity.

Tell them you want it but don't pay the premium unless you have to.

If you are injured during the 60 days, apply for COBRA (make sure someone close to you has access to the materials in case you are unable to apply yourself), and pay the premiums retroactively. I've never heard of anyone being denied coverage in this case...its a pretty common gambit.

 

[Venus21pam]

Thanks for your responses everyone!

Now I know exactly what I'm going to do.
My coverage expires as of May 31st. So I have 60 days from that date to accept or decline COBRA. My new insurance kicks in July 1st. So I will just wait and not sign anything (neither decline nor accept) unless anything happens in June. Sweet

 

[Winged Scapula]

Thanks for your responses everyone!

Now I know exactly what I'm going to do.
My coverage expires as of May 31st. So I have 60 days from that date to accept or decline COBRA. My new insurance kicks in July 1st. So I will just wait and not sign anything (neither decline nor accept) unless anything happens in June. Sweet

Be careful of those gators!

 

[Venus21pam]

Be careful of those gators!

Yeah, I will

And it looks like the fires in Florida are pretty close to Gainesville too.

 

[Engineer2MD]

Pre-med here, but I wanted to let you know...

I was in the exact same situation as you when I graduated college. Yes, COBRA must cover you retroactively. I did the same thing -- didn't pay it, but didn't decline it. I did get sick, so I paid the full balance owed and was given retroactive coverage. (needed a CT scan)

I wouldn't really recommend relying on COBRA though unless you have to. It was awful, the insurance company treated me like scum! They tried to deny every single claim I submitted.

Anyway, good luck!

 

[Venus21pam]

Pre-med here, but I wanted to let you know...

I was in the exact same situation as you when I graduated college. Yes, COBRA must cover you retroactively. I did the same thing -- didn't pay it, but didn't decline it. I did get sick, so I paid the full balance owed and was given retroactive coverage. (needed a CT scan)

I wouldn't really recommend relying on COBRA though unless you have to. It was awful, the insurance company treated me like scum! They tried to deny every single claim I submitted.

Anyway, good luck!

Thanks for your input.
I'm glad everything worked out with you in the end.
Hopefully that one month will be uneventful for me.

 

[blanche]

just a question, i honestly don't know...

let's say you do this plan, don't decline cobra and then don't pay, nothing bad health-wise happens and so you never pay anything. you start your new job, enroll in a new plan, ok fine.

then let's say two months later you are diagnosed with lymphoma, lupus, loa loa disease, something or other...do you think you could be denied coverage as a 'preexisting condition' since there was that 1-2 month period that you had cobra but never enrolled? so were actually uninsured? or are you considered 'insured' if you are simply eligable for cobra?

 

[dpmd]

Along the same lines, what if you have a chronic condition that won't need management during the one month period between insurance (since you have already stocked up on meds)? If you don't suck it up and pay the cobra, can they deny your care when you go for a follow up a few months later? Anyone have experience with this?

 

[Venus21pam]

OK dpmd and blanche, this is what I found out about the breaks in coverage:

A significant break in coverage that could cause denial of services in the future (d/t preexisting condition etc) is considered a break of 63 days or more.

This is an example that I found on the gov. website:

Q: I began employment with my current employer 45 days after my previous group health plan coverage terminated. I had coverage under my previous employer's plan for 24 continuous months prior to the termination. I had no other coverage before my enrollment date in my new plan, Will I be subject to the 12-month preexisting condition exclusion period imposed by my new employer?

A: Not if you enroll when you are first eligible. The 45-day break in coverage does not count as a significant break in coverage under HIPAA. Under federal law, a significant break in coverage is a break in coverage of at least 63 consecutive days. Since you had over 12 months of creditable coverage from your previous group plan without a significant break, you would not be subject to the preexisting condition exclusion period imposed by your new employer's plan if you enroll when you are first eligible.

If you want more info check this link:

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

Hope this helps.

 

[tibor75]

I wouldn't really recommend relying on COBRA though unless you have to. It was awful, the insurance company treated me like scum! They tried to deny every single claim I submitted.

Anyway, good luck!

You can't really avoid COBRA. You use anytime you change jobs since new insurance typically doens't kick in until you've worked at least 1 month.

 

[dpmd]

If you want more info check this link:

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

Hope this helps.

Thanks so much. I had forgotten that HIPAA dealt with this instead of just making us do a lot of extra privacy paperwork. That was a very helpful site.

Go Gators! My husband is one.

 

[blanche]

OK dpmd and blanche, this is what I found out about the breaks in coverage:

A significant break in coverage that could cause denial of services in the future (d/t preexisting condition etc) is considered a break of 63 days or more.

If you want more info check this link:

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

Hope this helps.

hey venus--
thanks for the info. i never realized that 63 days was the magic number! that seems so completely and entirely random...but i have such a pessimistic view towards health insurance that i wonder if the magic 63 days will always be the # that is honored.

in the past, i have gone with a 'gap' insurance called golden rule (http://www.goldenrule.com/) it can be as cheap as $35-40/month. it provides jack, except the fact that you will be covered by something. it has high deductables and anywhere from 20-50% patient responsiblity for costs (hey that sounds like our school's medical student plan now i think about it....)

i think it's a good idea if you are healthy, have minimum health care costs (ie healthy college graduates) and can't afford cobra and need something for more than a couple months.

 

[Doctor Bagel]

The answer is yes provided that you pay all the premiums back to the day when your employment ended. It sounds like you shouldn't be able to do it because it violates all our intuition about insurance, but you can. I specifically cleared this with my HR people when I quit work and researched it a lot online.

 

[Doctor Bagel]

I've had firsthand experience...

Tell them that you want the coverage, don't decline.

They'll tell you when the last day you have to pay before they'll drop your COBRA eligibility. Don't pay the premium if you don't have to...If you don't get sick, nothing lost. If you do, make a premium payment, and it's covered retroactive from day 1 of eligibility. HR schooled me on this common game years ago...

As far as showing a gap between coverages, tell the new insurance carrier you were in between jobs, and declined COBRA.

In the op's situation where he/she'll get insurance within 63 days, I don't think he even needs to say he wants it. He just needs to make sure not to decline it. If you're pushing beyond that 63rd days, then I guess you could say you want it at the last minute and then put off paying the premium until the last minute, always hoping that you'll never need to pay it. COBRA premiums are the devil.

As for the preex thing, that's been covered. As long as you're not uninsured beyond that magic number, you're good as long as you're moving from one group plan to another. Private plans and plans for students can be trickier. For example, my student plan excludes all pre-ex conditions within the first year if you were eligible for COBRA and didn't opt to take it for the maximum time.