Have we really lost our coverage?

June 17, 2009 8:19 AM

Help! My COBRA health insurance ended recently for a sketchy reason and I don't know how to get any answers and I need health care.

I live in Nevada. Our state has few options for health insurance. Individual premiums are sky-high and are routinely denied for pre-existing conditions. When my spouse got laid off in December, we signed up for COBRA. Every month we paid his old company for the policy. A week ago when he went to drop off the check there, he found that the company was in the process of being closed. The HR person there told him to pay our insurance company, Anthem, directly for the COBRA premium. He called Anthem and they told him the policy was closed because the company went out of business and the person at Anthem tried to get him to buy an individual policy instead. We tried that route before, but he was denied an individual policy due to pre-existing conditions. We are spinning our wheels trying to figure out what to do. Meanwhile, a family friend said that by law, we are entitled to COBRA for a certain period -- 18 months, I think -- regardless of whether the company went out of business or not. But I can't find any info out about this online. Can anyone please help clear this up ASAP as we are both dealing with some health problems and I do not have insurance from work? Thanks!

posted by xenophile to work & money (12 comments total)

Wow, tough situation.
Two thoughts:
1. My health insurance company will sell an individual policy to someone terming out of COBRA as long as they have been covered by the company within the last 3 months. It is a continuity of care issue, and pre-existing conditions don't apply. So check out the individual policy option.
2. The COBRA insurance is linked to the employer as far as level of benefits and premiums costs, so they might be right in saying that it ends with the company. COBRA does normally lasts 18 months, with an option to extend for 18 months in some cases.
posted by SLC Mom at 8:28 AM on June 17

Call your state's insurance commissioner. They will have the answers you need. COBRA has different rules depending on the size of the company you left. But your state's insurance commissioner is there to help you get this resolved.
posted by FergieBelle at 8:28 AM on June 17 [1 favorite]

The Consumer Services section of the Nevada Division of Insurance deals directly with all consumers by responding to a variety of requests for assistance. This includes answering all questions with regard to policies, claims, companies, etc., as well as handling all consumer complaints.

Consumer Health Complaints: 1-888-872-3234
posted by ND¢ at 8:38 AM on June 17 [2 favorites]

Well familiar with the ordeals of COBRA. Having dealt with this twice before, do not go through the state -- directly call the Federal Department of Labor. They are the ones who officially oversee everything. Not only can they provide you with information on how to do things, but in addition, if you have trouble getting the process underway (in my case, both times, Ceridian, a company who administers COBRA enrollment, had the enrollment and the money and still failed to process it for more than a month), federal labor department will be the enforcers.

So, get in touch with the Federal DoL.
posted by davidnc at 8:39 AM on June 17 [1 favorite]

According to this page, this page, you should be eligible for a HIPAA individual or family policy. In other words, if you've used up your COBRA coverage (and a company going out of business or cancelling their group policy pretty much uses up all your COBRA coverage by default, even if you haven't been insured under COBRA for the full 18 months) and have had some kind of group coverage for at least 18 months, insurance companies are required to offer you a HIPAA policy regardless of pre-existing conditions. It might actually even cost less than COBRA (though probably not if the federal government has been paying for part of your COBRA coverage under the economic recovery package).
posted by infinitywaltz at 8:40 AM on June 17

I was in a similar situation and it is true that COBRA is good for a set amount of months, but the company has to remain in existence. This Google Answer has some actual cites (see paragraph 3 and related links). Per SLC Mom's first comment, continuity of care is key. Go ahead and see if Anthem can shift you to an individual policy.
posted by mikepop at 8:45 AM on June 17

Quoted for truth: Call your state's insurance commissioner ... your state's insurance commissioner is there to help you get this resolved.
posted by FergieBelle at 11:28 AM on June 17

The Consumer Services section of the Nevada Division of Insurance ... Consumer Health Complaints: 1-888-872-3234
posted by ND¢ at 11:38 AM on June 17

Your state has an Attorney General, whose office is supposed to help you, as well as the Insurance Commissioner. They will have a website, as well as listings in the phone book. This is why they're there. Good luck; this must be a really crummy experience.
posted by theora55 at 9:00 AM on June 17

First, you need to be clear whether this is federal COBRA or a state continuation coverage situation, often called "mini-COBRA." Generally, it will be federal COBRA if the employer has more than 20 employees and is not a church plan. If it is a small employer, you will be dealing with the state insurance folks.

If it is federal COBRA, DOL has interpretive and regulatory jurisdiction only over the notice provisions of COBRA, so it is actually the Treasury Dept. that you want (unless this is a non-federal governmental plan, like a state agency or school district, and then you want Centers for Medicare and Medicaid Services).

Meanwhile, a family friend said that by law, we are entitled to COBRA for a certain period -- 18 months, I think -- regardless of whether the company went out of business or not.

This is not absolutely true, but it depends on what you mean by the employer's "closing." If the employer no longer provides group health coverage to any employees, it is not obligated to provide COBRA. For example, the closing of a location of a company's generally results in termination of employment and loss of health coverage. If the employer offers no other health benefit plans to anyone after the closing, employees have no rights to continuation coverage. However, if the employer maintains other plans—such as for other locations or divisions—employees retain their right to elect continuation coverage.
posted by Pax at 9:19 AM on June 17

the person at Anthem tried to get him to buy an individual policy instead. We tried that route before, but he was denied an individual policy due to pre-existing conditions.

So long as you have not has a period exceeding 63 days without continuous coverage - including COBRA - he cannot be denied coverage based on a pre-existing condition. It is one of the reasons for getting ANY coverage, no matter how minimal.

Now, this continuous care provision does allow them to take you on at the highest priced plan they have, which may be prohibitive, but they cannot refuse you outright.
posted by phearlez at 9:37 AM on June 17

So long as you have not has a period exceeding 63 days without continuous coverage - including COBRA - he cannot be denied coverage based on a pre-existing condition. It is one of the reasons for getting ANY coverage, no matter how minimal.

This is only true to an extent:


HIPAA guarantees access to individual insurance policies and state high-risk pools (without preexes, but most states don't put an upper limit on what they can charge, as discussed above). Individuals must:

1. Have had coverage for at least 18 months, most recently in a group health plan, without a significant break;

2. Have lost group coverage but not because of fraud or nonpayment of premiums;

3. Not be eligible for COBRA coverage; or if COBRA coverage was offered under Federal or state law, elected and exhausted it; and

4. Not be eligible for coverage under another group health plan, Medicare, or Medicaid; or have any other health insurance coverage.
posted by Pax at 9:52 AM on June 17 [1 favorite]

Call the US Department of Labor for clarification your rights. 1.866.444.3272
Also, this.
posted by ishotjr at 4:11 PM on June 17

If you find that you need to buy new insurance, I live in Nevada too and I LOVE LOVE LOVE my health insurance agent, Larry Harrison. Here is his website: http://www.insurenv.com/

I have no financial interest in his business, I'm just a very happy customer.
posted by Jacqueline at 7:14 PM on June 17