Q
Who is covered under
Mini-COBRA?
A
Those covered under
Mini-CORBA include former employees and eligible dependents who were
continuously insured under their group policy for an entire three-month period
ending with the employee’s termination.
Q Who is not available for continuation coverage
under Mini-COBRA?
A Mini-COBRA coverage is not available
for:
§
anyone covered under the
policy who is covered by, or is eligible for coverage under Medicare;
§
anyone who fails to verify
that he or she is ineligible for employer-based group health insurance as an
eligible dependent;
§
anyone who is a member of an
Individual medical plan, self-insured plan, or stand-alone dental plan;
§
anyone who is or could be
covered by any other insured or uninsured group health coverage arrangement and
under which the person was not covered immediately prior to such termination
(excluding Medical Assistance, CHIP, and adultBasic);
§
a group that is no longer a
viable business.
Q
What benefits will be available under the continuation
plan?
A
The same hospital, surgical,
or major medical benefits provided to everyone else under the plan.
Q
When will continuation coverage start?
A
Coverage will start on the
date of the qualifying event.
Q
When will continuation coverage end?
A
Coverage will terminate when
the former employee or eligible dependent is no longer eligible for the coverage
(see eligibility list above), or the first of the following triggering events:
§
nine months after coverage
terminated as a member of the group because of a qualifying
event;
§
the end of the period for
which the covered person paid a premium, if the covered person fails to make
timely payment of premium;
§
the date the group policy is
terminated.
Please note that if a former employee or eligible
dependent is no longer eligible for the coverage, he or she must notify the
administrator within 14 days of the triggering event.
Q
How much will continuing coverage
cost?
A
Mini-COBRA premiums will be
billed to the employer. Employers may be billed up to 105 percent of the current
group rate to cover the premium and administrative fees.
Q
Is there any assistance available for reducing the
Mini-COBRA premium?
A
The American Recovery and
Reinvestment Act (ARRA) of 2009 temporarily reduces the Mini-COBRA premium in
some cases. If a former employee or eligible dependent is eligible for
continuation coverage as a result of an involuntary termination during the
period from July 10, 2009, to December 31, 2009, he or she may be eligible for a
premium reduction through ARRA. Because of ARRA, the premium for continuation
coverage will be reduced to 35 percent, with IBC covering the remaining 65
percent.
Q
How does an involuntarily terminated employee apply for
the ARRA subsidy?
A
If your employee elects
Mini-COBRA continuation coverage and
believes that he or she meets the criteria for the premium reduction, please
complete the section of the application labeled – “Application for Treatment as
an Assistance Eligible Individual” and return it to IBC. You can find the
application online at www.ins.state.pa.us.
Q
Is everyone, who is involuntarily terminated, eligible
for a premium reduction through ARRA?
A
No. The following individuals
are not eligible for COBRA premium
assistance through ARRA:
§
individuals eligible for
other group health coverage (such as a spouse’s plan) or
Medicare;
§
individuals involuntarily
terminated prior to July 10, 2009, whether or not they elected
COBRA;
§
individuals terminated for
gross misconduct;
§
registered domestic partners or same-sex spouses.
Q
What are group leaders required to do?
A
When a qualifying event
occurs, group leaders are responsible for notifying the former employee and IBC
within 30 days. The Pennsylvania Insurance Department provides model notices on
its website, www.ins.state.pa.us, which
you can use to notify your employees.
Q
What are members required to do?
A
If a former employee or
eligible dependent elects to continue coverage under Pennsylvania Mini-COBRA, he
or she must complete the Mini-COBRA application and return it to you for
verification within 30 days of notice of the qualifying event. Group leaders
have 14 days to return the application to their independent broker, consultant,
or IBC account executive.
Q
Where is the application?
A
The application is available
online at www.ins.state.pa.us.
