Enrollment

What is COBRA Continuation Coverage?

Federal law requires that most group health plans (including this Plan) give employees and their families the opportunity to continue their health care coverage when there is a "qualifying event" that would result in a loss of coverage under an employer's plan. Depending on the type of qualifying event, "qualified beneficiaries" can include the employee covered under the group health plan, a covered employee's spouse, and dependent children of the covered employee.

Continuation coverage is the same coverage that the Plan gives to other participants or beneficiaries who aren't getting continuation coverage. Each "qualified beneficiary" (described below) who elects COBRA continuation coverage will have the same rights under the Plan as other participants or beneficiaries covered under the Plan.

You can learn more about COBRA continuation HERE.

Are there alternatives to COBRA coverage?

Yes. Instead of enrolling in COBRA continuation coverage, there may be other more affordable coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse's plan) through what is called a "special enrollment period." Some of these options may cost less than COBRA continuation coverage. You should compare your other coverage options with COBRA continuation coverage and choose the coverage that is best for you. For example, if you move to the other coverage you may pay more out of pocket than you would under COBRA because the new coverage may impose a new deductible. When you lose job-based health coverage, it is important that you choose carefully between COBRA continuation coverage and other coverage options, because once you have made your choice, it can be difficult or impossible to switch to another coverage option.

How long do I have to elect COBRA coverage?

You will have 60 days to elect COBRA coverage, measured from the date of your COBRA notice or the loss of coverage date, whichever is later. You will have an additional 45 days from the date of your COBRA election to remit payment, however, your enrollment will not be processed and you will not have coverage until your payment has been received.

How long will my COBRA coverage last? How long can I remain on COBRA?

You are entitled to a total of 18 months of Federal COBRA coverage. When you have exhausted your full 18 months of federal eligibility you may be eligible to extend your coverage for an additional 18 months on Cal-COBRA. Cal-COBRA is individual COBRA coverage administered directly by the carrier. You may contact the carrier directly should you have any questions regarding Cal-COBRA coverage.

If I waive coverage, can I change my mind?

If you reject COBRA continuation coverage before the due date, you may change your mind as long as you furnish a completed Election Form before the due date. However, if you change your mind after first rejecting COBRA continuation coverage, your COBRA continuation coverage will begin on the date you furnish the completed Election Form.

Will my plan change? Will I receive a new insurance card?

You will be enrolled on the same plans that you had when you were an active employee. Most carriers do not issue new ID cards for COBRA coverage and your member ID number will generally remain the same under COBRA.

Are you my new insurance carrier?

COBRA Simple is the third-party COBRA administrator and we are not associated with the insurance companies in any way. It is recommended that you contact your insurance carrier directly with any questions regarding claim issues or what is covered under your benefit plan.

Can I elect COBRA for myself only? Can I elect COBRA for my dependent only?

Yes, each qualified beneficiary is eligible to enroll on their own COBRA coverage.

Can I elect medical only?

You are not required to elect all benefits under COBRA. You do have the option of electing only individual plans (i.e.: medical only, dental only, medical and vision only, etc.)

Can I add dependents to my COBRA coverage?

Only dependents that were enrolled on the plan at the time of your COBRA qualifying event will be eligible to continue on COBRA. You cannot add dependents that were not previously enrolled on the plan unless it is the group’s annual Open Enrollment period.

The month is almost over and I haven’t used my insurance, can I elect COBRA effective next month?

Federal COBRA does not allow for a lapse in coverage and must begin the first day of the month following your COBRA qualifying event. Please keep in mind, your COBRA will begin retroactively even if you do not elect COBRA until the end of your 60 day election period.

Have you received my paperwork or payment?

We do not send out notifications when an enrollment and/or payment has been received, however, our system does allow COBRA participants to create an online account to view benefit and payment information online. Your COBRA paperwork will include login information including your own username and password. Once you have activated your account you will be able to check the status of your enrollment and see when a payment has been received and posted.

I already filled out all the carrier enrollment forms when I was an employee, do I have to fill them out again for COBRA?

Yes, the insurance carriers require enrollment or change forms when you enroll on COBRA coverage.

I sent in my enrollment paperwork and payment, am I covered?

Your COBRA enrollment forms will be submitted to the carriers within 24-48 hours from receipt of your paperwork and premium payment. Please keep in mind, the carriers can take 5-7 business days to complete your enrollment.

I need a prescription or have a doctor’s appointment but my enrollment has not been completed.

Carriers can take 5-7 business days to complete your COBRA enrollment. If you need to seek services or pick up prescriptions before your enrollment is completed, you can either pay out of pocket and then be reimbursed by the carrier, or you can request to be billed by the doctor and let them know your COBRA enrollment is in processing.

Where do I send my claims?

Please submit claims directly to the carrier for processing. COBRA Simple is not the insurance carrier and cannot process claims or reimbursements.

Payments

When is my payment due?

Your first monthly premium payment is required before your COBRA enrollment will be processed. After you are enrolled, COBRA premium payments are due on the first of each month and there is a 30 day grace period to send your premium payment each month.

It’s after the 1st of the month; can I still send my payment?

COBRA premium payments are due on the first of each month and there is a 30 day grace period to send your premium payment each month. Payment must be postmarked within the grace period in order to avoid termination. If you forgot to send your payment on the first of the month you may still send in the payment within the grace period. If the grace period has expired and payment was not received, your COBRA coverage will be terminated.

I forgot to mail my payment last month, can I send it now?

No. Premium payments must be post-marked within the 30 day grace period in order to avoid termination. Payments received with a post-mark date outside of the grace period will not be processed and will be returned to the qualified beneficiary, uncashed.

Can I make a payment online or over the phone?

We currently accept payment in the form of personal check, money order, or cashier’s check only. All payments should be made out to “COBRA Simple” and mailed to the address below:

COBRA Simple
20 Enterprise, Suite 330
Aliso Viejo, CA 92656

Can my premium payment be withdrawn from my bank account?

Please contact your bank for more information on the services they have available for you.

My check hasn’t cleared the bank, was it received (do I still have coverage)? Can you send me a notification when my payments are received?

We do not send e-mail confirmations when payments are received, however, our system does allow COBRA participants to create an online account to view benefit and payment information online. Please follow the link and login instructions in your COBRA packet to create your own account. Your coverage will always remain active with no lapse in coverage unless we do not receive payment postmarked within the 30 day grace period.

Will I receive a billing statement each month?

As soon as your COBRA enrollment has been processed we will mail premium payment coupons which will indicate your monthly COBRA premium amount due. As a courtesy we will send late-payment notices mid-month if your payment has not been received. Please keep in mind; you are responsible for sending your payment each month. Failure to remit payment within the 30 day grace period will result in termination of all COBRA coverage.

I need new premium payment coupons.

If you have run out of premium payment coupons please contact our office with your request via phone, fax, or e-mail.

Open Enrollment

I received a COBRA Open Enrollment packet, what do I do?

During the group’s Open Enrollment period you will have the opportunity to make adjustments to your COBRA coverage. You can also add or remove dependents from your coverage. All enrolled COBRA participants are required to return a completed COBRA Open Enrollment Form regardless of whether or not any changes are being made. If any of the carriers or benefit plans have changed or if you will be adding or deleting dependents you will also need to complete and return the carrier enrollment forms.

Termination

Can I cancel my COBRA coverage?

COBRA is a month-to-month coverage and can be terminated at any time. All voluntary termination requests must be submitted in writing, by e-mail, fax, or post. Termination requests must be received prior to the requested termination date or during the month of the requested effective date. Please note, you cannot retroactively terminate your coverage. For example, you may not terminate your coverage effective two months prior to the termination request.

How do I cancel my COBRA coverage?

Generally, you submit your request in writing, stating you wish to cancel coverage starting on a particular date. (Contact your former employer or its plan administrator for more details.) Or if you prefer, simply stop paying for your COBRA coverage when you want it to end. If payment is not received within the 30 day grace period your coverage will be automatically terminated due to non-payment.

My COBRA eligibility is ending – what are my options?

After you have completed your 18 months of Federal COBRA eligibility you may be eligible for 18 months of Cal-COBRA. Cal-COBRA is an individual COBRA coverage administered directly by the carrier and is an extension of your Federal COBRA coverage. *Please contact the carrier regarding extensions in states other than California.