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COBRA

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COBRA stands for the Consolidated Omnibus Reconciliation Act, which allows certain former employees the right to continue their current health insurance benefits.

This federal law amended the Internal Revenue Code, ERISA, and the Public Health Services Act to require most employers maintaining group health plans to offer employees, their spouses, and their dependents the opportunity to elect continuation coverage, on a self-pay basis, for 18, 29, or 36 months, depending on the qualifying event. Benefitexpress manages COBRA administration for VUMC.

How to Enroll

To be eligible for COBRA coverage, you need to meet these three requirements:

  1. You must be a qualified individual or beneficiary, which is based on your status on the day before the qualifying event. Qualified beneficiaries may include:
    1. Covered employees under a group health plan
    2. Covered spouses of covered employees
    3. Covered dependent children of covered employees
  2. You must experience a COBRA qualifying event
  3. You must lose group health plan coverage as a result of that event within a certain period of time

Read the Notification of COBRA Rights

FAQs

What are the COBRA qualifying events?
The qualifying COBRA events for employees and dependents are as follows:

  • Employees:
    1. Termination of employment (for reasons other than the employee’s gross misconduct)
    2. Reduction in the employee’s hours of employment
  • Employee's spouse or dependent child(ren):
    1. Termination of employment (for reasons other than the employee’s gross misconduct)
    2. Reduction in the employee's hours of employment
    3. Death of the employee
    4. Divorce or legal separation from the covered employee
    5. The employee's entitlement to Medicare
    6. The child's ceasing to be a covered dependent child under the terms of the plan
  • A qualified beneficiary who fails to elect COBRA continuation coverage in connection with a qualifying event ceases to be a qualified beneficiary once the COBRA election period expires.

Are there alternatives for health coverage other than COBRA?
If you become entitled to elect COBRA continuation coverage when you otherwise would lose group health coverage under a group health plan, you should consider all options you may have to get other health coverage before you make your decision. There may be more affordable or more generous coverage options for you and your family through other group health plan coverage (such as a spouse's plan), the Health Insurance Marketplace or Medicaid.
    Under the Health Insurance Portability and Accountability Act (HIPAA), if you or your dependents are losing eligibility for group health coverage, including eligibility for continuation coverage, you may have a right to special enroll (enroll without waiting until the next open season for enrollment) in other group health coverage.
    Eligibility for COBRA continuation coverage won't limit your eligibility for Marketplace coverage or for a tax credit. You can apply for Marketplace coverage at HealthCare.gov or by calling 1.800.318.2596 (TTY 1.855.889.4325).

What does HR need from me in order for my coverage to continue?
Once your department provides HR with the information qualifying you for COBRA, a COBRA notification letter and election form will be automatically generated and mailed to your home address. Each eligible employee and dependent will receive a letter and election form containing his/her specific election options. You have 60 days from the date contained on the COBRA notification letter to elect to continue your coverage. After you have made your COBRA election, you then have 45 days to make your initial payment. However, should you choose to maximize these election and payment time periods, your initial payment must be for premiums back to when coverage was lost in order for your coverage to be reinstated. See the My VUMC Benefits website for more information.

How long will my COBRA coverage last? For most employees, the COBRA period is 18 months. For an employee's family members, the COBRA period is 18 months if the qualifying event is the employee's termination or reduction in hours of employment and 36 months for all other qualifying events.

What happens if I fail to elect COBRA within 60 days?
If you fail to elect continuation coverage within the 60-day election period you will no longer be eligible to elect COBRA coverage with respect to that particular qualifying event once the election period expires. Once qualified beneficiary status is lost, the statute does not require that it be reinstated.

Where do I send my COBRA election form and payments?
Benefitexpress processes COBRA election forms, sends billing statements and receives payments. If you have any questions, please contact benefitexpress at 844.489.3745 or help@mybenefitsexpress.com. The mailing address is benefitexpress, 1700 East Golf Road, Suite 1000, Schaumburg, IL 60173.

After I make my initial payment, when are my monthly payments due going forward?
Payments are due by the 1st of each month (for the month in which coverage is intended) in order for benefits to continue.

How do I terminate my COBRA coverage?
To voluntarily terminate your COBRA coverage, complete the Request to Terminate Coverage form and return it to benefitexpress. Non-payment of premium is considered voluntary termination of benefits.

What happens if I fail to receive payment coupons?
Contact benefitexpress to request your account balance or payment coupons. To ensure the mailing of your coupons to the proper location, please notify benefitexpress immediately of any mailing address changes. You will not be sent regular premium notices. Please note, it is your responsibility to pay your premiums on or before the date due. Failure to do so does not relieve you of your responsibility of making timely premium payments and may terminate your participation in the plan.

Will benefitexpress notify me if my COBRA coverage is about to be terminated due to lack of payment?
No. It is the COBRA participant's responsibility to ensure that COBRA payments are made by the 1st of each month. VUMC is not required to check with a participant to see why his/her account is delinquent or to inquire as to whether the coverage is needed any longer prior to termination.

Rates

COBRA permits plan sponsors to charge qualified beneficiaries 100 percent of the cost of the coverage, plus an additional 2 percent. In the case of a qualified beneficiary entitled to 29 months of COBRA coverage resulting from disability, the plan sponsor generally can charge 150 percent of the cost of coverage for the additional 11 months.

See COBRA rates for 2017 and 2018 (VUnetID required).

Who to Contact

Contact the appropriate carriers, listed below, for claim information or to request a replacement identification card.


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