CobraEligibility rules for participation in the State Group Insurance Program through COBRA are based on the policies of the Group Insurance Program and federal legislation. Medical benefits through COBRA follow the same restrictions and guidelines as the State's group health plans. Benefits are outlined in the employee insurance handbook and the Plan Document. Effective January 1, 1997 Department of Finance and Administration Authorization No. 317082.
What is Cobra?The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) is a federal law that gives eligible employees and/or dependents, who would normally lose their group health coverage, the option of continuing their same insurance for a specific length of time under certain circumstances. COBRA was designed for employees and/or dependents who are losing their group health insurance benefits because of a job or family status change or ineligibility under the rules of their elected health plan. Through COBRA, individuals pay the entire monthly premium plus a 2% administrative fee, and may be able to remain insured with their existing health plan for up to 18, 29, or 36 months. All COBRA benefit questions should be directed to the Division of Insurance Administration at (615) 741-3590 or (800) 253-9981. Current premiums are available from the Division of Insurance Administration or a departmental insurance preparer. You may be entitled to have the State of Tennessee pay the premium for your ongoing health insurance. For information, contact your local department of human services.
Who is eligible?Any employee and/or dependent currently enrolled in the State's Group Insurance Program may be eligible to continue health insurance through COBRA if he/she is not eligible for Medicare or if not insured with another group health plan. The group health plan restriction will be waived if an individual enrolls in another group medical plan with a preexisting condition limitation that would not cover that individual's preexisting condition. To meet COBRA guidelines, an employee and/or dependent must be losing medical coverage due to one of the "qualifying events" listed below: Employees and dependents already insured may continue single or family medical coverage for a maximum of 18 months if coverage is lost because:
Dependents already insured may continue single or family medical coverage for a maximum of 36 months if they lose coverage because:
No one may extend health coverage through COBRA for more than 36 consecutive months from one employer. (For example, if the extension of coverage for a family began with the 18-month period and one of the covered dependent children becomes ineligible because of the age limit for dependents, the child must transfer to an individual, 36-month COBRA contract to continue coverage. The dependent's total months of coverage with both contracts may not exceed 36 months.) Employees and/or dependents continue the same health coverage they had with the State Group Insurance Program. The same medical benefits, guidelines, and restrictions apply. The monthly COBRA payments are 102 percent of the total monthly premium. Under COBRA, there will be no change in the process of submitting claims. For claim purposes, the identification number will be the social security number of the covered person, preceded by the appropriate letter. The following are letters for each plan: S - State Plan (Includes Central Government, Off-Line Agencies, the Tennessee Board of Regents School, and the University of Tennessee system). T - Local Education Plan (Includes K-12 Public School System Employees). G - Local Government (Includes City, County, and Quasi-Governmental agencies).
64000 Central Government, Off-Line Agencies 64100 University of Tennessee System 64200 Tennessee Board of Regents 64300 Local Education 64400 Local Government
Disability Extension:If a participant on an 18-month COBRA extension becomes disabled within the first 60 days of coverage, he/she may qualify for an 11-month extension. The monthly payments for months 19-29 increase to 150 percent of the total monthly premium. In order to qualify, an "award letter" from the Social Security Administration (SSA) must be sent by the COBRA participant to the Division of Insurance Administration within 60 days of SSA's disability determination. Coverage for disabled participants who qualify for this extension will end on the earliest of the dates outlined in "When Will My Coverage End?" or when the SSA determines the participant is no longer disabled. The COBRA participant must notify the Division of Insurance Administration within 30 days if SSA determines him/her no longer disabled. How Do I Enroll?Participation in COBRA is not automatic. To continue coverage through
COBRA, the employee or dependent MUST follow two important guidelines.
The Division of Insurance Administration will send a COBRA Notification Letter with an application to an employee's home address automatically within 30 days from the date insurance coverage terminates if:
It is very important that the application be signed by the "Appropriate Person."
The completed application must be returned to: Division of Insurance Administration
When Will Coverage End?Continuation of coverage through COBRA will end on the earliest of the following:
It is the employee's or dependent's responsibility to notify the Division of Insurance Administration in writing immediately when either event 1, 2, 3, or 4 occurs. When any of these six events occur, the employee or dependent is no longer eligible to continue health coverage through COBRA. Legal action will be taken to recover any benefits that were provided to an employee or dependent who was not eligible for coverage. All questions concerning eligibility rules should be directed to the Division of Insurance Administration at (615) 741-3590 or (800) 253-9981. Medicare Provision - If a former employee becomes eligible for Medicare during his or her 18-month extension, his/her covered dependents may continue coverage under a separate contract for up to 36 total months, including the months of coverage under the former employee's contract. The former employee must provide documentation of Medicare eligibility to the Division of Insurance Administration before the end of the 18-month extension.
Premiums:Premium payments are due by the first day of the month. Payment of your COBRA premium will be deducted electronically from your bank account each month. An ACH authorization form will be included with your enrollment materials. Once the ACH process begins, your premium will be deducted on the 15th of each month for that month's coverage. If you are unable to pay your premium electronically, call the Division of Insurance Administration and speak to a COBRA representative about paying monthly by check. If you choose to pay by check, any late payment will result in your coverage being automatically canceled. Premiums must be paid by the employee or dependent from the day coverage would have terminated. Premiums for the period from the date coverage would have ended to the date the Notification Letter is returned are called "back" premiums. Back premiums are due within 45 days of the date the application is signed and mailed. After the first COBRA premium is received, you will be mailed a new medical identification card. Acceptance of payment by the State does not guarantee coverage. If an employee and/or dependent is not eligible to extend coverage through COBRA or becomes ineligible after the extension begins, any premium payment(s) made after ineligibility occurs will be refunded to the employee or dependent. Any paid medical claims must be refunded to the appropriate health plan by the employee or dependent.
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