Cobra insurance expert

I have questions. Is there someone I could contact/ hire to explain my rights. The insurance guy I’ve used in the past doesn’t really have the legal answers I need. Is there an insurance lawyer?

Asking because I need surgery, not eligible for FMLA because it’s a newer job. I know I’ll pay my own premiums but my questions are more in-depth concerning surgery approval and timing of leaving my job. 

Note: I will be off for a considerable amount of time.

Thanks!

There are lawyers who specilaize in these topics, but you should expect to pay for their time.  I will point out that you are asking about two different things.  The surgery approval/coverage part is related to your actual medical plan and information pertianing to that should be in the plan documents availble either from your HR department and/or the insurance company.  How the plan functions should be the same whenther you are an active employee or enrolled under COBRA, as it is technically the same plan.  Your eligibility for COBRA continuation is based on a federal law.  You should generally be notified of your rights and how to enroll if you are actively covered by an employer sponsored plan and your employer is large enough to fall under the rules.  Start reading here:  https://www.dol.gov/general/topic/health-plans/cobra

This is correct. If you sign up for COBRA, your benefits should be the same as they are now.

That said, depending on the circumstances of losing your employer-provided coverage, you could be eligible for a Special Enrollment Period (SEP) on the Health Care Marketplace (Obamacare), meaning you can sign up outside of the open enrollment window. Again, depending on your exact situation, that may or may not be cheaper than COBRA.

Source: I write member materials for an insurance company.

I’m probably just paranoid that something will go wrong quitting my job to get the surgery that I need but the “  qualifying events” worries me somewhat. Going to Obamacare is not an option since   hospitals / doctors that I need are not covered under any of those plans. This is why I took this jobs 7 months ago, in case I needed surgery I would have better coverage.

rustybugkiller said:

I’m probably just paranoid that something will go wrong quitting my job to get the surgery that I need but the “  qualifying events” worries me somewhat. Going to Obamacare is not an option since   hospitals / doctors that I need are not covered under any of those plans. This is why I took this jobs 7 months ago, in case I needed surgery I would have better coverage.

How big is your company? At my company (and 3/4 total I've worked for), there has always been someone in HR who has acted like an ombudsman for things exactly like ths. 

FWIW, regardless of how long you've worked there and FMLA, you should not be quitting to get surgery. Go get surgery (and use all the vacation/sick time/PTO that you have), let them fire you, but don't quit. Put the monkey on their back.

Hope everything is ok healthwise and this is a minor surgery here. 

EDIT: Also, "Loss of current coverage", no matter how it occurs, is a qualifying event. And you can stay on Cobra for 18 months, which even though will likely be extremely expensive, is the same coverage that you have now.... just costing a lot more.

In reply to mtn : 

Company has 800+ employees. Insurance is expensive. I paid $600 a month for  Obama care with poor coverage last year. Whatever I pay under Cobra, will be better than paying outright for the two surgeries that I’ll need. 

rustybugkiller said:

In reply to mtn : 

 

Company has 800+ employees. Insurance is expensive. I paid $600 a month for  Obama care with poor coverage last year. Whatever I pay under Cobra, will be better than paying outright for the two surgeries that I’ll need. 

 

I'd talk to HR about this. Yeah yeah yeah, only there to protect the company, sure, but I've pretty much only found them helpful in the end, even if they do have to work through the process.

Before Obamacare, cobra coverage was ridiculously expensive, I don't know how that has changed but I can't imagine the price has gone down. Seriously, in the 90s COBRA coverage when my dad was unemployed was almost 2 grand a month, and the way insurance and employers have turned against employees since then...

Is short term disability an opinion? 

My experience is 20 years out of date, so I'm not sure how accurate it is anymore, but short term disability used to exist to protect your position for medical stuff that would take you out for under 12 weeks. They're not technically allowed to fire you, but they can "eliminate the position" if you're the only one in your work group, watched that happen when my dad was out for cancer treatments.

In reply to RevRico :

I used Cobra back in 2005 and I think it was $300-$400 a month. Cobra is whatever the company pays per person plus 2% for paperwork costs. 

My condition does not qualify for any type of disability.

edit: I forgot to mention that the company is self insured. I’m assuming that all of the above still applies.

I’m reviving this because now I have a surgery date and I still have questions. I’m still not eligible for Fmla so I will be paying my own way through Cobra program. 

Does anyone know how this transition works. Maybe someone on here has been through something similar. My surgery date is  the 24th. My last day of work will be the 17th. My employer knows that I want to take the Cobra option. What they haven’t been able to tell me is how long the transition will take. Will the hospital freak out that my insurance coverage stops on the 17th or will they know that I’m switching to Cobra. 

Basically I’m stressing out over all this stuff. Then the surgery and recovery itself will be no picnic.

Please tell me I’m worrying needlessly. Thanks!

rustybugkiller said:

My condition does not qualify for any type of disability.

edit: I forgot to mention that the company is self insured. 

Many companies are self insured, but pay someone else to manage like Blue Cross, Aetna, or another health insurance co. 

Something to keep in mind is that short term disability isn’t the same as long term or permanent disability. 

Short term disability typically bridges the gap between sick time (PTO) and long term disability. 

If the surgery is not elective (or even if it is) then I would strongly suggest that you investigate the short term disability aspect, and if you have coverage through your employer that would apply. 

On edit: I just saw that this was from July, so my post may not apply. 

Good luck and hopefully you have a smooth recovery and no insurance issues. 

No Time said:

rustybugkiller said:

My condition does not qualify for any type of disability.

edit: I forgot to mention that the company is self insured. 

 

Something to keep in mind is that short term disability isn’t the same as long term or permanent disability. 

Short term disability typically bridges the gap between sick time (PTO) and long term disability. 

If the surgery is not elective (or even if it is) then I would strongly suggest that you investigate the short term disability aspect, and if you have coverage through your employer that would apply. 

How exactly does one go to start the process of short term disability. Wont the process take longer than my disability time. I thought it took a year to get approved.

edit: I think you are thinking about employee based disability. Since I’m forced to resign from my job, I won’t have those company benefits 

In reply to rustybugkiller :

You are correct, I was thinking of the employer based short term disability insurance, so it no longer applies. 

is your last day at work on the 17th, but you are still employed, or are you unemployed on the 18th? Have you started the cobra process?

I would not resign until I knew I was covered, I'd go in for surgery and make them fire me, or resign after.

Go to your local social security office if you haven't already. BEFORE your surgery appointment and BEFORE you officially resign your position. 

I did mention this to a buddy that works for my local social security office when the thread was new(I thought it was weird you were voluntarily resigning before surgery), and this is pretty much what he does full time. There should be someone there that can help you and point you at everyone you need to be in touch with. 

Did you confirm the end date for your coverage?

Ive had some companies that coverage ended at the end of the month even if your last day was the 1st of the month, and others that had coverage end the day I left.  It’s worth checking

Additionally, last time I had a gap in coverage (2018) the HR person explained that there is a grace period where you can enroll in cobra after the end date for coverage as an employee ( I forget if it was 30 days or longer)  

Unfortunately, I resigned in writing that my last day will be the 17th. My policy will end on that date and Cobra would then begin. HR mentioned it would look better than being fired if I try to get another position and need to use them as a reference. I needed some time off before the surgery to get things ready for my recovery time.

Everything I’ve read shows that coverage will not be interrupted. I even mentioned to the hospital that I would be using/ going to Cobra and they did not see a problem.

what is the benefit of being fired as  opposed to resigning?

HR gave the number to contact Cobra services which I’ll call in the morning. I already know my monthly premium.

The last thing I need is for this to go the wrong way!! 

RevRico said:

Go to your local social security office if you haven't already. BEFORE your surgery appointment and BEFORE you officially resign your position. 

I did mention this to a buddy that works for my local social security office when the thread was new(I thought it was weird you were voluntarily resigning before surgery), and this is pretty much what he does full time. There should be someone there that can help you and point you at everyone you need to be in touch with. 

Can you explain further?

As I have read the SS office has nothing to do with my situation. I’m not eligible for disability/ SS benefits.

In reply to rustybugkiller :

You might be surprised about eligibility. Although I'm still very confused on the whole resigning for surgery bit. 

What Eric does is basically play go between for people that don't know what's going on with their health coverage but need things done. Surgery coming up but no job? Necessary medical care needed but even with insurance can't afford it?  Not having an option for short term disability? He handles stuff like this on a weekly basis

At the very least, give them a call and explain the situation. The earlier to get in touch with them the better, but even if they wind up denying you 6 months down the road when they finally get to actually reviewing the case, they can provide coverage up to that point with no penalty to you. At least that's how he's explained things to me when I've asked about surgeries that would make my life easier or mental health counseling. 

Worst case you're out a couple phone calls, maybe a couple hours of your time. Best case, one less headache during your recovery. 

I'm not an expert by any means, I just spent a large portion of my life seeing all the ways the health system and job system can berkeley with employees and people just trying to get by. In that time, I've learned some things, often the hard and expensive way, that could help make someone's life a little easier. Even if they can't help you in your specific situation, it could be useful information for someone else to have. 

Several articles mention quitting your job as a qualifying event and that is why I didn’t see an issue with resigning.

It sounds like you are alreasdy in touch with the COBRA administrator (often a third party your employer hires to amanage COBRA paperwork and premium collection), which is good as they will be the ones pulling the levers to get you enrolled and typically the ones you will be submitting the payments to.

The typical things that that happen in cases like this:
1. Your employer processes your termination internally in their payroll/HRIS.
2. The benefits administrator (insurance company) is notified of your loss of eligibility as an active employee.
3. At the same time as step 2 or shortly thereafter, the COBRA administrator is notified of your eligibility for COBRA continuation.
4. The COBRA administrator mails you a notice of COBRA eligbility, rate information and instructions on how to enroll.
5. You complete your COBRA enrollment per the administrators system and pay your first premium.
6. The COBRA administrator notifies the benefit administrator of your enrollemnt in COBRA continuation effective the day after you lost active coverage.

There is usually a period of time after losing active coverage where it will appear you don't have coverage if an inquiry is made during that time, until it is reactivated under COBRA.  The COBRA administrator may be your employer's HR department, but is usually a third party.  This process technically can be started before you actually leave, but a lot depends on your employer's and the third party's procedures and practices.  I believe your employer has 30 days to notify the plan administrator after you loose coverage, and you have 60 days to make your COBRA election.  It can often take weeks to receive notice and complete COBRA enrollemnt, but coverage is retroactive to when you originally lost your active coverage.

Quitting your job is absolutely a typical qualifying event.  If you do not receive your COBRA rights notice and an offer to enroll, you should have grounds for a legal action in my opinion.  Like I said, you should be able to get the ball rolling on enrollement if your employer is willing and able to help you do so.  In any case, you will be getting a letter in the mail from the COBRA administrator informing you of your eligbility.

In reply to (not) WilD (Matt) :

Thank you!

I did call the third party administrator and confirmed my  eligibility.  They encouraged me to contact the HR department and get the paperwork sent to them ahead of my final work date. I followed through with that and it sounds like the HR department is doing everything to make this go as quickly and easily as possible. I also called the  Federal office for cobra insurance to ensure that I am going to meet the eligibility requirements and they did not see an issue.  

I had a dentist appointment today so I’ll call the SS office tomorrow to see if there are any benefits available to me, I doubt it but who knows.