COBRA

Click here for current COBRA rates.  They are 102% of the full premium for the coverage desired.

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires employer-sponsored group health plans to offer continuing health care coverage at group rates for employees and their dependents who would otherwise lose health benefits upon the occurrence of certain events.  Such events include:

·         death of a covered employee

·         termination of a covered employee’s employment

·         reduction in hours of employment of a covered employee

·         divorce of a covered employee

·         a covered employee’s entitlement to Medicare

·         a covered dependent ceasing to be a dependent child under the terms of the plan

·         an employer’s commencement of bankruptcy proceeding.

(detailed definitions of qualifying events are contained in the law itself – click on http://www.dol.gov/ebsa/newsroom/fscobra.html for more information).

AACPS is required by COBRA to extend employees the option to continue lost coverage for 18 months to terminating employees or those with reduction in hours.  All other qualifying events, except bankruptcy, have a COBRA continuation period of 36 months.  Coverage is retroactive to the first of the month following the month active AACPS coverage terminates.  For example, if a dependent is no longer a full-time student in May, active coverage ends 5/31 and the COBRA effective date is 6/1.

AACPS’ COBRA administrator is Self-Funding Administrators (SFA).  SFA will send out COBRA notifications to COBRA eligible participants based on the above criteria.  COBRA eligible participants must notify SFA of intention to continue coverage within 60 days calculated from the date of letter or date of qualifying event whichever is later.  SFA will enroll the applicant in COBRA once the election form and initial payment are received.

Note that COBRA eligible participants electing COBRA, including graduating dependents, must select the same healthcare plan as currently enrolled.  However, if you are enrolled in the Aetna or BlueChoice HMO and move out of the area, you must enroll in the PPN plan. 

Generally, continuation of coverage will remain in force until the earlier of:

·         the date payments are not submitted on a timely basis

·         the date the COBRA beneficiary notifies HR/Benefits of intention to terminate

·         the date the COBRA beneficiary becomes eligible for coverage that is not subject to pre-existing limitations.

Regarding loss of status as a dependent child, continuation of healthcare coverage through the AACPS COBRA plan is available to graduates and dependents not returning to college.  AACPS requests student status updates (via an “Important Notice”) every year in April and November (open enrollment).  If a dependent is not returning to college for the next semester, this notice should be faxed to HR/Benefits in the spring at 410-222-5610 or verified on-line during the fall open enrollment period.  Upon receipt of information that a dependent is not returning to college or graduating, AACPS will request SFA to notify the qualifying COBRA dependent.

As stated above, the graduating dependent must select the same healthcare plan as currently used, but will require individual coverage only.  If dropping a dependent means a change in plan level (e.g. family changes to husband/wife) this change will automatically be processed by HR/Benefits.  Other less costly options for individual coverage can be found at www.mdinsurance.state.md.us/documents/hipaalistrev3-30-04-Web.pdf.  Additional possible sites to visit (not necessarily endorsed by AACPS) are:  www.gradmed.com, Celtic Health Insurance at http://www.celtic-net.com/ (customer service 1-800-477-7870), www.carefirst.com (local phone number 410-268-6488) and other managed care plans, which offer individual policies (e.g. KaiserPermanente and Mamsi).

It is the employee’s legal obligation to notify AACPS of any lifestyle change affecting a change in dependent status.  AACPS and its healthcare carriers will conduct periodic audits of dependent enrollments for all employees with dependent coverage.  It is fraudulent to include your dependents on the AACPS health plan when they do not meet eligibility requirements.  Claims paid for ineligible dependents will be recouped by the healthcare vendor from the provider, which could possibly cause you to be financially liable.

For additional information about specifics of COBRA coverage, COBRA rights and COBRA costs, please contact SFA at 410-757-4200.  For additional information, you may visit SFA’s On-line Participant Information Center (OPIC).  This convenient resource will provide you with a comprehensive overview of your benefits, detail contact information, and links to various carrier websites.  Click on the “Online Services” link on the SFA home page to access the Secure Login Page.  Log in using “AACPS” and use the password “BENEFIT” (all uppercase).