Hi philaderie,
Not to worry, your sister should be able to keep COBRA until Medicare
kicks in as long as she meets all of the requirements on time. COBRA
consists of:
1) Initial 18 month group coverage
2) 11 month group Disability Extention (premium will be at 150% of
initial coverage)
3) Option to convert to individual health coverage for remaining period of time
1) US Department of Health and Human Services
Centers for Medicare and Medicaid Services
Standard Periods of Coverage
"The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
establishes required periods of coverage for continuation health
benefits. COBRA beneficiaries generally are eligible for group
coverage during a maximum period of 18 months for a qualifying event
of employment termination or reduction of employment hours. Other
qualifying events may entitle a spouse and dependent children to a
total of 36 months of COBRA coverage."
Employment termination: 18 months
http://www.cms.hhs.gov/COBRAContinuationofCov/05_StandardPeriodsofCoverage.asp#TopOfPage
2) US Department of Health and Human Services
Centers for Medicare and Medicaid Services
Extended Periods of Coverage
"29-Month Period (Disability Extension): Special rules for disabled
individuals and certain family members may entitle them to an 11-month
extension of Consolidated Omnibus Budget Reconciliation Act of 1985
(COBRA) continuation coverage (from 18 to 29 months). Specifically,
if a qualified beneficiary is determined under Title II or XVI of the
Social Security Act to have been disabled within the first 60 days of
COBRA coverage, then that qualified beneficiary and all of the
qualified beneficiaries in his or her family may be able to extend
COBRA continuation coverage for up to an additional 11 months. (An
individual who has been determined under Title II or Title XVI of the
Social Security Act to have been disabled before the first day of
COBRA continuation coverage, and who has not been determined to be no
longer disabled at any time between the date of that disability
determination and the first day of COBRA continuation coverage, is
considered to be disabled within the first 60 days of COBRA
continuation coverage.)
However, qualified beneficiaries may lose all rights to the additional
11 months of coverage if notice of the determination is not provided
to the plan administrator within 60 days of the date of the
determination (when the determination is issued during the initial
18-month period of COBRA coverage) and before the expiration of the
18-month period. The qualified beneficiary who is disabled or any
qualified beneficiaries in his or her family may notify the plan
administrator of the determination. (Click on ?Notices Required of
Qualified Beneficiaries? on the left navigation bar.)"
http://www.cms.hhs.gov/COBRAContinuationofCov/06_ExtendedPeriodsofCoverage.asp#TopOfPage
Frequently Asked Questions about COBRA Continuation Health Coverage
Can individuals qualify for longer periods of COBRA continuation coverage?
"Yes, disability can extend the 18 month period of continuation
coverage for a qualifying event that is a termination of employment or
reduction of hours. To qualify for additional months of COBRA
continuation coverage, the qualified beneficiary must:
* Have a ruling from the Social Security Administration that he or
she became disabled within the first 60 days of COBRA continuation
coverage
* Send the plan a copy of the Social Security ruling letter within
60 days of receipt, but prior to expiration of the 18-month period of
coverage
If these requirements are met, the entire family qualifies for an
additional 11 months of COBRA continuation coverage. Plans can charge
150% of the premium cost for the extended period of coverage."
http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html
3) US Department of Health and Human Services
Centers for Medicare and Medicaid Services
Other Coverage Considerations
"Although COBRA specifies certain periods of time that continued
health coverage must be offered to qualified beneficiaries, COBRA does
not prohibit plans from providing continuation coverage beyond the
periods required by COBRA. Also, some plans allow participants and
beneficiaries to convert group health coverage to an individual
policy. If this option is available from the plan, the COBRA law
gives you the right to exercise that option when you reach the end of
your COBRA continuation coverage. The plan must offer a qualified
beneficiary the option of enrollment in a conversion health plan
within 180 days before COBRA coverage ends. The premium for a
conversion policy may be more expensive than the COBRA premium, and
the conversion policy may provide a lower level of coverage. The
conversion option, however, is not available if the qualified
beneficiary ends COBRA coverage before reaching the end of the maximum
period of coverage.
Important Note: One of the conditions that must be met to obtain
individual health coverage as a HIPAA-eligible individual is that the
individual's most recent period of coverage must be employer-sponsored
group health plan coverage. COBRA coverage meets that requirement; a
COBRA conversion policy does not. Federal law does not give an
individual who takes a COBRA conversion policy a right to switch from
the conversion policy to other individual health coverage on a
guaranteed available basis."
http://www.cms.hhs.gov/COBRAContinuationofCov/13_OtherCoverageConsiderations.asp
What Happens When COBRA Ends?
"Last month?s column described how someone could stay on their
employer?s health insurance even after they stop working there. But
COBRA only lasts 18 months for terminating employees. What happens
after that?
There are two federal laws that can be used to continue health
insurance once your COBRA Continuation Coverage ends. Both provide
access to health insurance without having to prove that you are
?insurable.?
1. If you leave work due to disability??
"COBRA was amended to allow people, who had to stop work due to
disability, to extend the time they can keep COBRA Continuation. Under
this law, someone who qualifies may stay on their employer?s COBRA
Continuation until they become eligible for Medicare, which is
normally 29 months after they leave work due to disability.
However, to qualify for this extension of COBRA, you must meet several
requirements:
1. You must apply for Social Security Disability Insurance (SSDI) benefits.
2. Social Security must approve your benefits during your initial 18
month COBRA period.
3. The Onset Date of your disability, must be within 60 days of the
start of your COBRA coverage.
4. Finally, you must provide a copy of your Social Security Notice of
Award letter to your COBRA
administrator within 60 days of receiving it AND within 18 month COBRA period."
This is a good way to stayed insured since it allows you to stay on
your employer?s health insurance plan until you become eligible for
Medicare. The primary drawback is that during the months after the
first 18 months of COBRA, the employer can (and will) charge you the
actual premium PLUS 50%. For example, if you were paying $200 per
month on COBRA, the extended months will cost $300 per month."
How It Works
"Once your COBRA Continuation coverage ends, the insurance company or
administrator is required to send you what is called a ?Certificate of
Creditable Coverage? which is usually simply a letter confirming the
starting and stopping dates of your coverage with them. Upon
presenting that letter to the HIPAA plan or carrier, the plan is
required to let you purchase the coverage. Thanks to these two laws,
now, if you ever become insured under an employer health plan, you
will be permitted to maintain health insurance indefinitely, even
after your employment terminates."
http://www.hcvadvocate.org/hepatitis/About_Hepatitis_pdf/1.1.1_Living_With_HepatitisC/cobra-2.pdf
It's a bit complicated but I hope I've been able to help you see
through the maze. If you have any questions, please post a
clarification request and wait for me to respond before closing/rating
my answer.
Thank you,
hummer
Google Search Terms Used: cobra extension continuation
I also searched the Centers for Medicare and Medicaid Services website. |
