In deciding whether to elect Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) continuation coverage, you should consider all your health care options.  For instance, one option that may be available is "special enrollment" in a group health plan sponsored by a spouse's employer, if enrollment is requested within 30 days of loss of your health coverage.  (If you decide to elect COBRA coverage, special enrollment also is available in a spouse's plan after COBRA continuation coverage is exhausted).  The special enrollment right is provided by the Health Insurance Portability and Accountability Act (HIPAA) and permits an individual who loses group health plan or health insurance coverage to enroll in a spouse's plan without having to wait for an open enrollment period.  If a group health plan provided by a spouse's employer is insured by a health insurance carrier, contact your state's department of insurance for more information about special enrollment rights.  Also, regarding special enrollment in a plan maintained by a state or local government employer, you can contact CMS at 1-877-267-2323 extension 61565.

If the group health plan provided by a spouse's employer is a self-funded, private sector (not a state or local government) plan, contact the Employee Benefits Security Administration, Department of Labor (telephone # 1-866-444-3272 (toll free) or 202-219-8776).

Also, individuals in a family may be eligible for health insurance coverage through various state programs.  For more information about state programs, contact your state's department of insurance.

If you elect COBRA continuation coverage, options that may have been available to you before electing COBRA coverage may still be available after COBRA coverage is exhausted.  Additionally, you and your family may qualify for individual health coverage as "HIPAA-eligible individuals" when COBRA coverage is exhausted. (COBRA coverage is exhausted when it ends for any reason other than either failure of the individual to pay premiums on a timely basis or for cause, such as making a fraudulent claim.)

HIPAA eligible individuals are eligible to purchase individual health coverage on a guaranteed available basis with no exclusion period for preexisting medical conditions.  Certain criteria must be met.  For more information about obtaining individual health coverage as a "HIPAA-eligible individual," contact your state's department of insurance, preferably before your COBRA coverage ends.  Also, you can contact CMS at 1-877-267-2323 extension 61565.

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.

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Page Last Modified: 04/18/2008 3:53:54 PM
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