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Q: Medical Insurance Coverage ( Answered 4 out of 5 stars,   3 Comments )
Question  
Subject: Medical Insurance Coverage
Category: Health
Asked by: stu-ga
List Price: $50.00
Posted: 25 Apr 2002 18:46 PDT
Expires: 02 May 2002 18:46 PDT
Question ID: 6100
I had major surgery several months ago, with the expenses covered by
my current employer's medical plan (Cigna). I have been on medical
disability leave since June 2001, but my employer has continued to
cover insurance payments. I plan to resign from this employer (or be
layed off) at the end of May. In either circumstance, I assume I will
be entitled to 18 months of Cobra; Is that correct? This is further
complicated by the fact that my employer is being aaquired by another
company, which uses another insurance plan (United Health Care). If my
current company goes out of business after I sign up for Cobra with
Cigna, will my Cobra end or am I still guaranteed the full 18 months?
Further, if the acquiring company closes the acquyisition anytime
before June one and puts me on their United Health Care plan, will
United 1) have to offer me Cobra when I resign or get layed off from
the new company and 2) will United Health Care, in that circumstance,
have to continue coverage for my post operative (liver transplant)
care? I need Cobra coverage until long term disability medicare will
start, in mid-2003. It is not expected that I will ever be able to
return to work.
Thank you.
Answer  
Subject: Re: Medical Insurance Coverage
Answered By: missy-ga on 25 Apr 2002 19:55 PDT
Rated:4 out of 5 stars
 
Dear stu-ga, 

Thank you for your inquiry.  Please note that the answers given by
Google Answers researchers should not be considered professional
advice.  It is strongly recommended that you contact your Human
Resources department or Benefits Administration personnel at your
company for specific details pertaining to your situation.

According to the COBRA FAQ, any termination of employment *except* for
gross employee misconduct leaves you eligible for at least 18 months
of COBRA coverage. [http://www.probusiness.com/fsa_cobra/Q_and_A/cobra_faq.asp#What
is a qualifying event?]

Under normal circumstances, your COBRA coverage would indeed extend
for the entire 18 months.  Your situation is complicated by the fact
that your company is being acquired.  This is where things get tricky.
 According to Insure.com, if you enroll for COBRA coverage, then your
company goes out of business, you will no longer be covered by COBRA -
COBRA coverage applies to group plans.  If your employer disappears,
so does the group insurance plan under which you were covered, and
your COBRA benefits would cease.
[http://www.insure.com/health/faq/bankrupt.html]
[http://www.probusiness.com/fsa_cobra/Q_and_A/cobra_faq.asp#What is
the definition of Group Health Plan?].

(The example above addresses a company which has gone bankrupt, though
it seems to also apply if the acquiring company opts not to
immediately cover all employees at your current company.  If there is
any gap between your coverage under your current plan and coverage
under the new plan, you would not be eligible for COBRA.)

If the acquiring company offers immediate or overlapping coverage and
you are enrolled in their group plan *prior to your termination of
employment*, you should be eligible for the full 18 month COBRA
coverage.  You *must* be enrolled in the new plan before you are
eligible for any COBRA
benefits.[http://www.insure.com/health/cobra.html]

Generally, when an employer changes health plans (either voluntarily
or due to acquisition), the new insurer will continue to cover
previous treatments as long as the employee maintained continuous
coverage under the old plan prior to diagnosis and during the entire
course of treatment.  Insurers' policies vary wildly, so be certain to
check with your Benefits Administrator.

(My husband's company switched health care on us mid-pregnancy, and
asked only for my care record for that pregnancy.  In our case it was
a virtually seamless transition.)

It may be helpful to you to read through the text of the 1986 COBRA
law, in order to understand your rights and responsibilities under the
plan:
[http://cobrainsurance.net/COBRA_Law.htm]

Cobrainsurance.net offers a comprehensive list of COBRA resource links
[http://cobrainsurance.net/COBRA_Links.htm], most notably a list of
insurance information sites available:

COBRA Insurance Information [http://www.cobrainsurance.net]  
Short Term Insurance [http://www.temporaryinsuranceplan.com]  
Student Insurance [http://www.studentshealthinsurance.com]  
(among others)

Insure.com offers a free forum in which to ask health insurance
questions.  Since insurance laws vary by state, they will ask for your
state as well as your insurer.
[http://www.insure.com/health/forum/question.html]

They also offer a summary of your rights under COBRA, including a
state by state listing of all Department of Labor offices, to whom you
should address questions regarding your specific COBRA situation.
[http://www.insure.com/health/cobra.html]

It might also be helpful for you to check the websites of your current
and (potentially) future insurers:

[http://www.cigna.com/consumer/index.html]
[www.unitedhealthcare.com/]

I hope this information will help you get the exact answers you need. 
My sincere wishes for your continued health!

Best regards,

missy-ga
stu-ga rated this answer:4 out of 5 stars

Comments  
Subject: Re: Medical Insurance Coverage
From: cjerian-ga on 25 Apr 2002 21:58 PDT
 
There is one exception to cobra coverage that is becoming more
important.
If  you employer closes down or goes bankrupt, then you  are not
entitled to cobra coverage.  This happened recently to Nexsi, where
the company didn't get anymore money from Sequoia Capital and closed
down, the workers could not get any Cobra coverage.
Subject: Re: Medical Insurance Coverage
From: missy-ga on 30 Apr 2002 20:08 PDT
 
Um, cjerian?

I covered that in the third paragraph.  Thoroughly.  With two links
and a parenthetical.
Subject: Re: Medical Insurance Coverage
From: press-ga on 14 Jun 2002 15:09 PDT
 
Stu

There is a clear difference in your health choices based on whether
you are laid off or you quit.

COBRA is basically designed for people who are laid off.

If companies merge there will be a transition to the new health
coverage
if the health companies are not the same but doctors may not be on
both plans.

If you quit be sure to keep records of when you quit. Your prior
health plan would be responsible for all prior charges up to that
point. Afterwards talk with the hospital about your case often they
will be willing to give you a discount but don't expect more than 20%
off the bill and they will also work out
a payment plan. Regardless your health is most important so if your
transplant cost drive you to bankruptcy then so be it. Nothing more
important than good health and many people recover from bankruptcy.

Also many health care plans farm out their transplant services if so
then talk directly with the company that is responsible for the
transplant.

SO under COBRA yes you get coverage as long as you pay your premium.
If the companies there is usually at least a 90 day grace period so
you should be ok.

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