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FAQ - Frequently Asked Questions

 
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COBRA
COBRA

What is COBRA?
COBRA stands for the Consolidated Omnibus Budget Reconciliation Act of 1985. The legislation was signed into law on April 7, 1986.

COBRA amended federal law to require most employers to offer temporary continuation coverage to employees and dependents who would otherwise lose group health plan coverage because of certain "qualifying events." The legislation provides certain employees and dependents with coverage during the period between loss of coverage and obtaining other coverage, at group rates.
 

What is a qualifying event?
In general, an event is considered a qualifying event only if it meets all of the following conditions:
- It is one of the designated events under COBRA
- The event causes the qualified beneficiary to lose group health plan coverage provided by the employer
- The event occurs while the plan is subject to COBRA
 

What are the six "designated events"?
Generally, the following refer to the six “designated events:”
1. Covered employee's termination of employment - for any reason other than gross misconduct or a covered employee's reduction in hours to fewer than the number required to participate in the plan;
2. Covered employee's divorce or legal separation from spouse;
3. Covered employee's death;
4. Covered employee's entitlement to Medicare under Title XVIII of the Social Security Act;
5. Covered child's loss of dependent status under the generally applicable terms of the plan; or
6. Retiree's (or a retiree's spouse's or child's) substantial loss or elimination of coverage within one year of (before or after) the employer's filing of a Title XI bankruptcy proceeding on or after July 1, 1986.

An employee can only have 1 or 6 as an event. A spouse can have all of the above except for 5. A child can have all of the above as a qualifying event.
 

What is a "Qualified Beneficiary"?
A qualified beneficiary is someone who was covered under the Plan(s) immediately preceding the qualifying event and will lose coverage under the Plan because of the qualifying event. Depending on the type of qualifying event, employees, spouses of employees, and dependent children of employees (including infants born and children adopted during COBRA coverage) may be qualified beneficiaries.
 

Generally, what are the coverage periods?
Losing coverage due to:
- Termination of Employment (except for gross misconduct) or Reduction in Hours - 18 months coverage
- Death of Employee - 36 months coverage
- Employee's Medicare Entitlement - 36 months coverage
- Divorce or Legal Separation (applies to Spouse and Dependents) - 36 months coverage
- Dependent Child Ages-Out of Plan (applies to Dependents) - 36 months coverage

COBRA Timeframes
- 30 Days - Employer Reports Event to Plan Administrator
- 14 Days - Administrator Notifies Qualified Beneficiary
- 60 Days - COBRA Election Period
- 45 Days - First Premium Payment Due*

*Retroactive premium from loss of coverage to date of election; amount accrued
 

What types of enrollment changes can be made at the time of the COBRA event?
Generally, when an event occurs, you can choose to continue your existing coverage (i.e. medical, dental, etc.). You may not change from one plan to another, unless it is during a designated open enrollment period. You may however, change from Family to Individual coverage, though you may not change from Individual to Family coverage.
 

Do I have to elect to continue all of the coverage’s that I was enrolled in prior to my COBRA event?
No, you may choose to continue only some of the coverage’s that you already have. For example, at the time of the COBRA event, if you are enrolled in Medical, Dental and Vision coverage, you may then choose to only continue Medical, or any combination of the three. However, if you were not already enrolled in a benefit plan (i.e. dental), you may not add it at the time of the COBRA event.
 

How long will it take for my health insurance coverage to be reinstated with the insurance carrier(s) once I have mailed in my initial COBRA payment?
Once your initial premium payment is submitted to Crosby, your coverage will be reinstated approximately 2 to 3 weeks from the date you mail in your payment. Your coverage will be retroactively reinstated to the loss of coverage date.
 

While my coverage is being reinstated with the insurance carrier(s), what should I do if I have a medical appointment or prescriptions to fill?
Many health care providers and pharmacies understand the COBRA process and may be able to accommodate your needs while you wait for your COBRA coverage to be reinstated back to the date on which you lost your coverage. If you incur expenses, once your coverage has been reinstated, you may submit those expenses to your health insurance carrier for reimbursement. Please contact your health insurance carrier directly for information about the reimbursement process.
 

How do I actively terminate my COBRA coverage?
If you wish to actively terminate your COBRA coverage, you must notify Crosby in writing. The cancellation will be effective the first of the month following receipt of your written request and you will be responsible for premiums until that date.
 

Under what circumstances could my coverage be terminated?
Continuation coverage may be terminated before the end of the maximum period if:
- Any required premium is not paid in full on time;
- A qualified beneficiary becomes covered, after electing continuation coverage, under another group health plan that does not impose any pre-existing condition exclusion for a pre-existing condition of the qualified beneficiary;
- A covered employee becomes entitled to Medicare benefits (under Part A, Part B, or both) after electing continuation coverage;
- The employer ceases to provide any group health plan for its employees.
- A qualified beneficiary who has received an extension of continuation coverage due to an SSA disability determination is subsequently determined by SSA to no longer be disabled; or,
- The qualified beneficiary provides written notice to the COBRA plan record keeper (Crosby) that they wish to cancel continuation coverage.

Continuation coverage may also be terminated for any reason the Plan would terminate coverage of a participant or beneficiary not receiving continuation coverage (such as fraud).
 

What is ACH?
ACH refers to Automatic Clearing House – if you enroll in ACH, you are authorizing Crosby to pull the premium due each month from either your checking account or savings account.
 

Can COBRA payments be made over the phone?
No. Payments can be made by check or ACH.
 

What happens if I submit a COBRA enrollment form without a payment?
You will not be enrolled in COBRA continuation coverage until we receive the first premium payment. You have 45 days from the postmark date on the enrollment form to make the payment.
 

Can you explain the premium computation form?
The Premium Computation form is a schedule of payments due if you enroll in COBRA. It starts with the first month’s payment and then lists each subsequent additional month’s premium to the total.
 

Can COBRA be extended?
An 11-month extension of coverage may be available if any of the qualified beneficiaries is determined by the Social Security Administration (SSA) to be disabled.
 

When is the deadline to enroll in COBRA?
The deadline to enroll in COBRA is listed on the first page of the COBRA packet and is generally 60 days from the loss of coverage date or mail date, whichever is later.
 

Can I enroll before my employment is terminated?
You can enroll in COBRA once your coverage in the active employee plan has been terminated. Often times we do not receive notification to offer COBRA until after the termination has occurred. There are special situations where a packet is sent out prior to the term date and if paperwork is returned timely, enrollment will be in place prior to the active coverage ending.
 

Can you provide me with a quote?
No, Crosby cannot quote verbally. This information is included in your notification packet.
 

Who do I call about denied claims?
Please call the member services number listed on your subscriber ID card.
 

Can I change from family to individual or the reverse at anytime?
Yes, you can always lower your coverage from family to individual. To increase your coverage from individual to family, the change can only be done at open enrollment or if you experience a qualifying event during the plan year (i.e. birth of a child).
 

I cannot afford the whole amount at one time. Can I make two payments per month?
Yes, as long as payment is completed within the 30 day grace period.
 

Who is WageWorks?
Crosby Benefit Systems has become a part of WageWorks, Inc. on May 1, 2013. WageWorks is a leading on-demand provider of tax-advantaged programs for consumer-directed health, commuter and other employee spending account benefits, including FSAs, HSAs, HRAs, parking and transit programs.
 

What does this change mean for Crosby?
Crosby chose to become a division of WageWorks to benefit from the extensive expertise, technology, and service resources a leading national administrator can offer. Crosby will continue to provide service to clients and participants from our office in Newton. We will operate as a local office, with close ties to our clients. Our phone numbers and websites will remain the same.
 

What is myRSC?
myRSC, or My Resource Service Center, is a web portal for COBRA and Direct Bill participants. Through this site, participants can access their account information, make premium payments, setup ongoing ACH, and for COBRA participants, enroll in COBRA.