Frequently Asked Questions
for COBRA Participants

P.Q.B. stands for Primary Qualified Beneficiary. This includes any employee or eligible family member that was covered under the employers medical, dental, vision or health Flexible Spending Account (FSA) plan prior to the loss of coverage.

EAP stands for Employee Assistance Program and is a referral/counseling service. It is a toll-free number that is available 24 hours a day, seven days a week, 365 days a year. It also provides face-to-face counseling sessions. It can help with such issues as marital and relationship issues/ parenting issues/ substance abuse/ anxiety/ depression/ anger/ legal questions/ financial issues/ coping with change/bereavement of grief/low self-esteem.

Most clients have their own bank accounts that we deposit their checks into, therefore, checks must be made payable to the client (not WageWorks, formerly Creative Benefits).

It depends on the carrier. Most carriers will send updated cards with new COBRA group numbers. They can continue to use the old card (letting the doctors know that they are now on COBRA) until the new one is received.

Yes. Any lapse of coverage under a group health plan during FMLA leave is irrelevant in determining whether a set of circumstances constitutes a qualifying event.

If:
(1) during the first 60-days of continuation coverage, the Social Security Administration determined you to be disabled, and if
(2) you notified the plan administrator within 60-days after the date of determination but before the end of the 18-month initial period, and if
(3) the Qualifying Event (QE) was termination or reduction in hours,

then:
(1) coverage for all beneficiaries would be extended to 29 months and
(2) premium adjustments to the Qualified Beneficiary (QB) would be 150% for the final 11 months of coverage.

If you have a qualifying event and are entitled to Medicare at the time of the qualifying event--they are entitled to full COBRA continuation (Medicare has no impact on COBRA in that instance). The only time Medicare entitlement impacts COBRA is when the entitlement occurs after a COBRA election has been made---in that case, the COBRA may be terminated. See Geissel v. Moore Medical (supreme court decision).

No. Address changes need to be submitted in writing. This eliminates possible miscommunication or interpretation of address information and provides a hard copy documented audit trail providing authorization for address correction. Download a Change of Address form here.

Unless your plans are being eliminated, you do not need to do anything. Begin paying your premiums with the new payment coupons at the new rates for the new plan year.

There are two ways to terminate your coverage:
(1) You can fax, email or send in writing by mail, an informal letter of termination stating that you would like to drop your coverage. Include the date, your SSN and your former employer and also include what date you would like to drop the coverage.
(2) Do not send a check or anything else. It will not do damage to your credit and if we have not received payment by the due date, we will send a letter of termination of coverage to you.

A written letter (by fax, email or regular mail) that includes employee/parent name, former employer, SSN, baby’s name, date of birth and baby’s SSN, along with a check for the extra amount for the newborns coverage. This must be turned in within 30 days of the event.

No. Claims for services should be forwarded your insurance carriers for reimbursement.

Call WageWorks, formerly Creative Benefits, and we will research your coverage status with the insurance carrier. Once we have completed the research or resolved the issue, our Participant Support Specialist will notify you of the results.

Yes. We can issue a HIPAA certificate and mail it to your home. It will show your status as “currently enrolled” unless your account is completely paid through your COBRA end date. You will receive another HIPAA certificate when you end your COBRA coverage. This will show your COBRA coverage end date. We cannot send it to a third party.

You cannot continue under COBRA for additional time unless:
(1) You are deemed permanently disabled by the SS Administration within the first 60-days of your initial COBRA coverage. The premium rate will go up to 150% of the amount you initially paid.
(2) You are over 60 at the time of your termination and were employed for 5 years or more. The premium rate will go up to 213%.
(3) If you are a CA resident and your COBRA started on or after January 1, 2003, you may continue for an additional 18 months. The premium rate could increase to 110%.

You would need to contact your insurance carrier or review your plan’s Summary Plan Description for this information.

If your employer goes out of business and does not have any active plans available, all COBRA participants will lose coverage as well. If the former employer does not offer any alternative for employees, then the participants will be responsible for finding individual coverage for themselves.

Depending on what plan(s) you are enrolled in, you may need to switch to a plan that is available in your area or you may lose access to continued coverage if no coverage is available. (Most HMO’s are state specific and you would be required to switch to a PPO plan.)

If it is not a self-funded medical plan then it is usually convertible to an individual policy. Dental and vision plans are not typically convertible.

If you were covered under that health plan before you were on COBRA, then you can continue both plans. However, if you become covered under any plan after your COBRA coverage start date, you cannot continue COBRA as a secondary coverage.