Question
What is the name of your state? Indiana
My husband left his previous employer on 7-31-06. We have never received any COBRA information or paperwork. We each have called the employer requesting information and updates. On 11-26-06, the company did not even have a case started for him. I now have a case number and have been told they are "researching" the problem. I was also told that the company changed administrators at the same time that my husband left and his paperwork "got lost in the scuffle". The previous insurance company had paid some bills in August and was notified on 9-28, that our insurance was cancelled. The insurance agency is now contacting the doctors and hospital to get reimbursed since we did not have insurance at the time. What do we do now? I think they are in violation of the law, but how to do pressure the employer for the COBRA information? How do I stop the doctors/hospitals from harassing me for payment? What recourse do I have against the employer for not sending the information? ThanksWhat is the name of your state?
Answer
You're in a bind, but PART of it is your husband's fault. If you weren't getting information from his company, he should have contacted the department of insurance in your state for help.
What group health plans are subject to COBRA?
The law generally covers health plans maintained by private-sector employers with 20 or more employees, employee organizations, or state or local governments.
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What process must individuals follow to elect COBRA continuation coverage?
Employers must notify plan administrators of a qualifying event within 30 days after an employee's death, termination, reduced hours of employment or entitlement to Medicare.
A qualified beneficiary must notify the plan administrator of a qualifying event within 60 days after divorce or legal separation or a child's ceasing to be covered as a dependent under plan rules.
Plan participants and beneficiaries generally must be sent an election notice not later than 14 days after the plan administrator receives notice that a qualifying event has occurred. The individual then has 60 days to decide whether to elect COBRA continuation coverage. The person has 45 days after electing coverage to pay the initial premium.
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How long after a qualifying event do I have to elect COBRA coverage?
Qualified beneficiaries must be given an election period during which each qualified beneficiary may choose whether to elect COBRA coverage. Each qualified beneficiary may independently elect COBRA coverage. A covered employee or the covered employee's spouse may elect COBRA coverage on behalf of all other qualified beneficiaries. A parent or legal guardian may elect on behalf of a minor child. Qualified beneficiaries must be given at least 60 days for the election. This period is measured from the later of the coverage loss date or the date the COBRA election notice is provided by the employer or plan administrator. The election notice must be provided in person or by first class mail within 14 days after the plan administrator receives notice that a qualifying event has occurred.
How do I find out about COBRA coverage and how do I elect to take it?
Employers or health plan administrators must provide an initial general notice if you are entitled to COBRA benefits. You probably received the initial notice about COBRA coverage when you were hired.
When you are no longer eligible for health coverage, your employer has to provide you with a specific notice regarding your rights to COBRA continuation benefits.
Employers must notify their plan administrators within 30 days after an employee's termination or after a reduction in hours that causes and employee to lose health benefits.
The plan administrator must provide notice to individual employees of their right to elect COBRA coverage within 14 days after the administrator has received notice from the employer.
You must respond to this notice and elect COBRA coverage by the 60th day after the written notice is sent or the day health care coverage ceased, whichever is later. Otherwise, you will lose all rights to COBRA benefits.
Spouses and dependent children covered under your health plan have an independent right to elect COBRA coverage upon your termination or reduction in hours. If, for instance, you have a family member with an illness at the time you are laid off, that person alone can elect coverage.
Answer
The US DOL, not the state insurance commission, oversees COBRA violations.
Answer
Your husband knew his employment ended in July and that you didn't have COBRA, so who went to the doctor after that time and what did you tell the office and/or hospital???
I have worked in the medical field for many years and outside of an emergency, I have never heard of a hospital not securing payment or at least means of payment in advance. From a private doctor's office point of view, any one worth their salt should have had you pay in advance and be reimbursed when the COBRA situation was straightened out. That would have given your husband the impetus to research his coverage and find out what is going on.
Knowing you didn't have coverage but running up a bill anyway is irresponsible.
Just my two cents.
Answer
Your husband knew his employment ended in July and that you didn't have COBRA, so who went to the doctor after that time and what did you tell the office and/or hospital???
I have worked in the medical field for many years and outside of an emergency, I have never heard of a hospital not securing payment or at least means of payment in advance. From a private doctor's office point of view, any one worth their salt should have had you pay in advance and be reimbursed when the COBRA situation was straightened out. That would have given your husband the impetus to research his coverage and find out what is going on.
Knowing you didn't have coverage but running up a bill anyway is irresponsible.
Just my two cents.
The hospital probably did get confirmation of coverage on the DOS because the insurance co. wasn't notified of the termination until 9/28.
I totally agree with your "pay in advance, then get reimbursed" comment for the private Doctor's office. It works like a charm.
Answer
You're right, Lealea. I missed the part about the insurance being notified at the end of September. But OP still KNEW they hadn't paid COBRA premiums for August or September, so they should have known that their coverage was in question, at the very least.
That's the second time you have agreed with me...I like the way you think!
Have a great evening!