COBRA

Jan 18, 2007

  1. aufan
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    aufan Super Genius

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    This has probably been addressed somewhere on this forum but I have a question about Cobra. If a person has a major medical claim while on Cobra, does HIPPA protect that client longer than the 18 month extension of benefits? In other words, after 18 months will he then be off Cobra and possibly be uninsurable?

    Hope I explained that clear enough. Any thoughts?
     
    aufan, Jan 18, 2007
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  2. Crabcake Johnny
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    Crabcake Johnny Guru

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    Once he expires Cobra the state MUST have a HIPAA option for him. It's either a state plan or a carrier like Blue Cross but he cannot be denied medical insurance.

    There are situations where Cobra can go longer than 18 months - I believe a disablity is one of them.
     
  3. Guest
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    Guest Guest

    In California you get CalCobra which is an additional 18 months. COBRA only effects employees who work for firms that have 20 or more people. If you work for 19 or less you get 18 months of CalCOBRA. I'm told that if you work for a large company you HAVE to take both federal COBRA and CalCOBRA, 36 months, before you are eligilbe for a HIPAA plan (assuming you can afford it.)

    In CA every carrier must provide a HIPAA plan and it has to be one of their 'popular' plans... not sure how that is defined.

    Al
     
    Guest, Jan 18, 2007
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  4. Crabcake Johnny
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    Crabcake Johnny Guru

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    http://www.cobrainsurance.com/COBRA_FAQ.htm


    How long must COBRA continuation coverage be available to a qualified beneficiary?

    Up to 18 months for covered employees, as well as their spouses and their dependents, when workers otherwise would lose coverage because of a termination or reduction of hours.
    Up to 29 months is available to employees who are determined to have been disabled at any time during the first 60 days of COBRA coverage and applies as well to the disabled employee's nondisabled qualified beneficiaries.
    Up to 36 months for spouses and dependents facing a loss of employer-provided coverage due to an employee's death, a divorce or legal separation, or certain other "qualifying events".
     
  5. aufan
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    aufan Super Genius

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    Thanks guys....good info.
     
    aufan, Jan 18, 2007
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  6. Dave020
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    Dave020 Super Moderator Moderator

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    HIPAA requires that a mandatory guaranteed-issue health option be made available to those exhausting group benefits (either continuation or loss of group in the event the employer dumps the plan).

    Each state is free to interpret the implementation of HIPAA as it best sees fit. Some states have it integrated directly into their major risk pools, while others have it more privatized.

    In answer to the question above, California requires any carrier selling individual & family health plans under CA registration (DOI or DMHC) to provide TWO of their most popularly marketed plans to the HIPAA marketplace (2 for each registration and many carriers in CA are now putting all PPO through DOI due to hassles with DMHC). There are really only a handful of carriers in California selling in that market, and often you will see two sets of identical PPO plans available under HIPAA (see Blue Shield CA & Blue Shield Life & Health) which creates confusion as the carrier has registered one set with DMHC and one set with DOI.

    As to Cal-COBRA, 36 months for all qualifed beneficiaries. Over 20, 18 months federal COBRA followed by a second 18 months on Cal-COBRA (with rate increase from 102% to 110%). If under 20, 36 months of Cal-COBRA. Certain plans are exempt from the extension to 36 months - self funded/self-insured, out of state domiciled plans and HRA/HSA PPO plans with higher deductible which can be considered self-funded. This is all covered by AB 1401 in California.

    For HIPAA in CA, DMHC does exert influence as they control the pricing arrangement as it is integrated with MRMIP. So, the carriers have to provide the plans but DMHC determines pricing for those plans based on the MRMIP pricing levels for premiums.

    If you like, you can read about all this good stuff on my site
    www.davefluker.com

    Dave
     
    Dave020, Jan 18, 2007
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  7. Sam
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    Sam Founder Administrator

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    Thanks Dave, thats some good info. I also like your website. Very original.
     
    Sam, Jan 18, 2007
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  8. Dave020
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    Dave020 Super Moderator Moderator

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    Thanks, the site is the result of many versions and revisions and trial and error. I do it all myself so that I can control the content and make updates at my convenience.

    I am glad I found this forum, there are too few health insurance forums online and much good information doesn't get passed on to those who need it.

    Dave
     
    Dave020, Jan 18, 2007
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  9. Guest
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    Guest Guest

    Nice site but it does not render well with Macintosh Safari nor Firefox on the Mac. Lots of text that overlap graphics.

    Lots of sites don't render with Safari, but the vast majority do with Firefox. So you might want to check that out to make sure it works with Firefox on PCs.

    Since we Mac users are a tiny minority it's probably not a big deal.

    Al
    http://www.insurancesolutions123.com
     
    Guest, Jan 18, 2007
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  10. Sam
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    Sam Founder Administrator

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    Al,
    I only use Firefox, and it looks fine to me, I don't see any problems.
     
    Sam, Jan 18, 2007
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