Tricky COBRA question: COBRA and new group plan simultaneously?
September 27, 2013 1:40 PM Subscribe
I'm trying to help someone be in the best position with healthcare benefits. It sounds like they may be able to be covered by both their COBRA continuation plan *and* a new group plan through a spouse's employer. There's some tricky wording in the COBRA rules. Is this possible?
Goal: get this person double covered under 1) COBRA plan and 2) spouse's employer's group health plan for the entire month of September.
Relevant dates:
- Qualifying Event (and last day of coverage under this person's previous employer group health plan): 8/31/2013
- Deadline to enroll in spouse's employer's group health plan (with retroactive coverage to 9/1/2013): 9/30/2013
- Deadline to enroll in COBRA plan (with retroactive coverage to 9/1/2013): November 1, 2013
The question: can this person be covered under both the COBRA plan and the new group plan?
Based on the DOL's COBRA FAQs (Q14: How long does COBRA coverage last?): "[coverage] may end earlier if ... After the COBRA election, coverage is obtained with another employer group health plan that does not contain any exclusion or limitation with respect to any pre-existing condition of such beneficiary. However, if other group health coverage is obtained prior to the COBRA election, COBRA coverage may not be discontinued, even if the other coverage continues after the COBRA election."
Do I understand this correctly to indicate that if they sign up for spouse's employer's plan on Sept 30, then elect COBRA at a later date (e.g. 10/15/2013) this person will be covered under both plans?
There is a much longer COBRA compliance document for employers that does mention that coverage can end early, but does not include the relevant bit from above ("However, if other group health coverage is obtained prior to the COBRA election, COBRA coverage may not be discontinued, even if the other coverage continues after the COBRA election.") The Early Termination section of this PDF starts at bottom of page 16.
Additional data point: the new group plan does have restrictions for pre-existing conditions, but this person would not be subject to those restrictions because there would be no gap in coverage.
Considering these rules, can this person be covered under both plans?
In the event that this person had both a COBRA plan and a new plan active for the month of September, how would claims be handled? The COBRA plan has a lower deductible and covers a higher percentage of any medical bills than the new group plan.
Goal: get this person double covered under 1) COBRA plan and 2) spouse's employer's group health plan for the entire month of September.
Relevant dates:
- Qualifying Event (and last day of coverage under this person's previous employer group health plan): 8/31/2013
- Deadline to enroll in spouse's employer's group health plan (with retroactive coverage to 9/1/2013): 9/30/2013
- Deadline to enroll in COBRA plan (with retroactive coverage to 9/1/2013): November 1, 2013
The question: can this person be covered under both the COBRA plan and the new group plan?
Based on the DOL's COBRA FAQs (Q14: How long does COBRA coverage last?): "[coverage] may end earlier if ... After the COBRA election, coverage is obtained with another employer group health plan that does not contain any exclusion or limitation with respect to any pre-existing condition of such beneficiary. However, if other group health coverage is obtained prior to the COBRA election, COBRA coverage may not be discontinued, even if the other coverage continues after the COBRA election."
Do I understand this correctly to indicate that if they sign up for spouse's employer's plan on Sept 30, then elect COBRA at a later date (e.g. 10/15/2013) this person will be covered under both plans?
There is a much longer COBRA compliance document for employers that does mention that coverage can end early, but does not include the relevant bit from above ("However, if other group health coverage is obtained prior to the COBRA election, COBRA coverage may not be discontinued, even if the other coverage continues after the COBRA election.") The Early Termination section of this PDF starts at bottom of page 16.
Additional data point: the new group plan does have restrictions for pre-existing conditions, but this person would not be subject to those restrictions because there would be no gap in coverage.
Considering these rules, can this person be covered under both plans?
In the event that this person had both a COBRA plan and a new plan active for the month of September, how would claims be handled? The COBRA plan has a lower deductible and covers a higher percentage of any medical bills than the new group plan.
As a general rule, being double covered is more trouble than its worth, because each insurer will argue that the other one should cover any medical costs you incur. You are likely to end up doing a lot of arguing with both insurers, writing letters, making frustrated phone calls and so on, before you get either of them to pay up.
posted by Joh at 2:16 PM on September 27, 2013 [2 favorites]
posted by Joh at 2:16 PM on September 27, 2013 [2 favorites]
Most employer group plans don't allow double coverage, plus, COBRA coverage is usually super expensive (depending on former employer's plan) so there really isn't any advantage to signing up for both. Luckily, it looks like (based on dates given) there won't be any gap in coverage.
posted by PorcineWithMe at 3:15 PM on September 27, 2013
posted by PorcineWithMe at 3:15 PM on September 27, 2013
No, one of the exclusions for continuing COBRA is becoming eligible for another group insurance plan.(works in the industry).
posted by nubianinthedesert at 4:59 PM on September 27, 2013
posted by nubianinthedesert at 4:59 PM on September 27, 2013
Think of it this way too: COBRA is actually continuation of the previous employer's grouop health plan ... which means even though you're not still with your employer, you're still on their insurance roles. Then, you'd also be on your spouse's employer's roles. Knowing what we know about employers, they're not gonna both want to pay for that.
posted by nubianinthedesert at 5:00 PM on September 27, 2013
posted by nubianinthedesert at 5:00 PM on September 27, 2013
Why would you want to do this? I am having trouble understanding your solution without understanding the problem that you are trying to solve.
I seem to remember from filling out medical forms that when filing a claim, you have to answer a question about whether you have alternate coverage. The goal of the insurance company being to not pay a claim if someone else is responsible for it. There are rules about which carrier becomes primary and secondary. I don't think the rules are set up to let someone get more than their share, so to speak. If, for example, your primary carrier covers at the 90% level, and your secondary carrier covers at the 80% level, you won't get anything extra from the secondary carrier. If it is the other way around, you *might* get the other 10% out of the secondary.
posted by gjc at 12:23 PM on September 28, 2013
I seem to remember from filling out medical forms that when filing a claim, you have to answer a question about whether you have alternate coverage. The goal of the insurance company being to not pay a claim if someone else is responsible for it. There are rules about which carrier becomes primary and secondary. I don't think the rules are set up to let someone get more than their share, so to speak. If, for example, your primary carrier covers at the 90% level, and your secondary carrier covers at the 80% level, you won't get anything extra from the secondary carrier. If it is the other way around, you *might* get the other 10% out of the secondary.
posted by gjc at 12:23 PM on September 28, 2013
« Older How to deal with jealousy and loathing; Sibling... | Help me figure out a customer service system for... Newer »
This thread is closed to new comments.
Insurance is 'special snowflake' I doubt anyone here can tell you with assurance that it's one way or the other.
What would be the benefit to be double covered?
posted by Ruthless Bunny at 1:48 PM on September 27, 2013