COBRA Information, Benefit Continuation, Costs, Participant Toolkit | TRI-AD
Alert
  • TRI-AD's websites will be unavailable during a scheduled maintenance window that will begin Saturday, October 1, 2016, at 2:00 p.m. Pacific Time. We expect to have all systems back online at or before 5:00 a.m. Pacific Time on Sunday, October 2, 2016.

  • TRI-AD has partnered with GetInsured, a web-based portal offering affordable alternatives to COBRA. You can purchase individual health and dental insurance under the Marketplaces or directly through the major insurers. Click here to find out more.

COBRA

FAQs

When will my active benefits end?
Your active benefits will stop either the day you terminate employment or at the end of the month in which you are terminated. Contact TRI-AD for the exact date your active benefits will end.
When will I receive information telling me how I can continue my benefits?
Within a few weeks after you terminate, the TRI-AD Continuation of Benefits Department will send you a COBRA Enrollment Kit containing a COBRA Enrollment Form with coverage information and rates, and information about your COBRA rights. If you wish to continue your medical, dental, and/or vision coverage, enroll online on TRI-AD's website or complete the COBRA Enrollment Form and return it to TRI-AD at the following address:
TRI-AD Continuation of Benefits Department
P O Box 2059
Escondido, CA 92033
Fax: 760-233-4742
If you have any questions regarding your COBRA eligibility or payments, please contact the TRI-AD Continuation of Benefits Department directly at 888-844-1372.
How long do I have to decide if I want to elect COBRA?
Your enrollment form must be postmarked within 60 days from the later of the date your active benefits end or the COBRA notification is sent to you (your Last Day to Elect is on the COBRA Enrollment Form). After that date, you will no longer have the right to elect COBRA coverage.
When will my coverage be reinstated?
Upon receipt of your completed form and premium payment (or confirmation of company-paid time), your coverage will be reinstated back to the date your active coverage ended.
What if my company is paying some of my COBRA benefits?
If you have signed a Severance Agreement that provides company-paid benefits for your medical, dental, and vision coverage, you must still complete the COBRA Enrollment Form and send it to TRI-AD in order to receive the company-paid benefits.
Why do I have to pay premiums back so far?
COBRA law requires that you pay the monthly premium retroactive to the date your active coverage ended, so that you do not have a gap in coverage. Payment of your retroactive amounts must be postmarked within 45 days of your COBRA election.
How can I get benefits and services during the interim between the end of my active coverage and the reinstatement of my COBRA coverage?
Here are suggestions for obtaining needed services during this gap in coverage (remember that when you elect and pay for COBRA coverage, the gap will get filled in):
  • Prescription Coverage: If you need a prescription, you may have to pay for it yourself (do not go without medication you need). If the prescription is very expensive, the pharmacy may be able to provide a few days' worth to tide you over. After your benefits are reconnected, the pharmacy will usually make the copay adjustment over the counter for you, or you can submit it to your medical provider for reimbursement.
  • Doctor's Visit: You may have to pay for the visit and then submit it for reimbursement. The doctor's office may be willing to hold or resubmit the bill when your coverage is reactivated.
  • Preauthorization: If you need medical treatment for which preauthorization is necessary, please contact the TRI-AD Continuation of Benefits Department so we can assist in getting your coverage activated.
What coverages can I elect to continue under COBRA?
You may continue the same
coverage(s) you had as an active employee. For example, if you had HMO medical, DMO dental, and vision coverage, you may continue some or all of those coverages.
Who can I cover under COBRA?
You and/or any of your eligible dependents who were covered at the time of your Qualifying Event may elect to continue COBRA coverage.
If I elect COBRA, am I obligated to pay for the full COBRA period?
No. You may drop COBRA coverage at any time (generally at the end of a month). You may also drop part of your coverage (i.e., dental or vision) or dependents at any time. However, you may not add coverage or dependents except at Open Enrollment or in case of a family status change.

More..

When may I change the type of coverage I have?
You may change the type of coverage at Open Enrollment, just the same as an active employee. For example, you could change from the HMO medical to a PPO medical plan. You must notify TRI-AD in writing within 31 days of any address change, as this may affect the type of coverage available to you.
Can I ever add dependents to my coverage?
Yes, when you have a qualified family status change. These changes are:
  • Birth or adoption of a child
  • Marriage
  • Gain or loss of coverage by eligible dependent
  • Divorce or legal separation
  • Dependent child becoming ineligible due to age or change in student status.
You must notify TRI-AD in writing within 31 days of any family status change.
How long can my COBRA coverage last?
Maximum Period Qualifying Event
18 Months Termination of Employment, Reduction in Hours, or Retirement
29 Months Total and Permanent Disability, as determined under the Social Security Act
36 Months (for Dependents only) Divorce or Legal Separation, Death of Employee, Child Ceases to be Dependent (i.e., Over-Age), or Employee Becomes Entitled to Medicare
When does my COBRA coverage end?
Coverage will end at the end of your COBRA coverage period. For most people, this is 18 months, or earlier if any of the following occur:
  • The monthly premium is not paid within the 30-day grace period; or
  • You become Medicare eligible; or
  • You become eligible under another group health plan; or
  • The plan terminates for all employees; or
  • A disabled person is no longer disabled during the 11-month extension period.
If any of these events occur, you must notify the TRI-AD Continuation of Benefits Department immediately.
How much do I pay for COBRA coverage?
Here are the rates that apply for COBRA coverage:
You pay 102% of the active employee premium (both employer and employee portions) for the coverage you elect. The rate will be provided in your COBRA information package.

Please note that the rates are subject to change.

If you are eligible for the disability extension, during the additional 11 months of coverage, the cost for that coverage may be approximately 150% of the active employee rates. (You must notify TRI-AD of any Social Security disability extension within 60 days of your receiving that determination.)
Can I still have COBRA if I am covered under Medicare?
If you were covered under Medicare while you were still working as an active employee, you may elect COBRA and have coverage under both COBRA and Medicare. However, if you elect COBRA coverage and then become entitled to Medicare (enroll in Medicare), you must drop your COBRA coverage.
Where do I submit claims to get them paid?
Your COBRA coverage is exactly the same coverage you had as an active employee. Usually you can use the same card, submit claims in the same way, and call the same Customer Service Number you used previously.
I've heard that in California I can extend my COBRA for an additional 18 months. Is that true?
This extension is called Cal-COBRA (under AB 1401), and it would be provided directly by your health plan insurer. Contact the Customer Service number on your medical card for more information. If you qualify for the coverage, the rate may be 110% of the active employee rates. Note that this extension does NOT apply to self-funded plans, and it does not apply to dental, vision, or EAP coverage.
What is the Affordable Care Act (Health Care Reform) law change and what I am required to do?
In 2014, most U.S. citizens are required to have minimum essential health coverage or they MAY face a penalty for not having health coverage. If you enroll in a Marketplace health plan or enroll in your former employer’s group health plans through COBRA, you will be considered as having minimum essential coverage (and your family if applicable) and as long as you stay enrolled each month, you will not incur a penalty. Enrolling in just dental, vision or other non-health plans offered through COBRA is not considered minimum essential coverage. Go to www.healthcare.gov for more information.
What is a Marketplace and how do I find more information about my state’s Marketplace?
The Marketplace is a tool where individuals can purchase health insurance coverage for them and their family. Each state is required to provide a Marketplace where its residents can purchase health plans. Some states built their own Marketplaces and some states partnered or fully relied on the Federal government to provide Marketplaces. Go to www.healthcare.gov for more information
What if I have not yet enrolled in COBRA - can I enroll in a Marketplace rather than enroll in COBRA?
Yes, During the Marketplace enrollment periods, individuals are eligible to enroll and obtain health benefits in a state Marketplace. The open enrollment period for 2015 is 11/15/14 – 2/15/15. Healthcare coverage can take effect as early as 1/1/15. We suggest you go to www.healthcare.gov for more enrollment information. Keep in mind, certain benefits such as dental, vision, EAP may not be available through the Marketplace. If you have these benefits, you can continue those benefits through COBRA unless your dental/vision/EAP plan is bundled with the medical plan and you drop your COBRA medical plan.
What if I am already enrolled in COBRA - can I enroll in my state’s Marketplace health plan even though I am enrolled in COBRA?
Individuals are eligible to enroll and obtain health benefits in a state Marketplace during the Marketplace annual enrollment periods. We suggest you go to www.healthcare.gov for more information. If you stay enrolled in COBRA and do not elect to move to your state’s Marketplace health plan, you may not be able to enroll in your state’s Marketplace after the Marketplace enrollment period ends. If you wish to stop your COBRA benefits, before you stop paying your COBRA premiums, you should check with your state’s Marketplace to be sure you can enroll in their benefits prior to terminating your COBRA coverage. If you fail to make a COBRA payment on or before the end of the grace period, you will lose COBRA coverage. Keep in mind, certain benefits such as dental, vision, EAP may not be available through the Marketplace. If you have these benefits, you can continue those benefits through COBRA unless your dental/vision/EAP plan is bundled with the medical plan and you drop your COBRA medical plan.
What happens if I enroll in COBRA and then later change my mind and wish to enroll in the Marketplace health plans?
In some situations, you may not be able to enroll in your state’s Marketplace after the Marketplace enrollment period ends each year. Before you stop paying your COBRA premiums, you should check with your state’s Marketplace to be sure you can enroll in their health benefits prior to terminating your COBRA coverage. If you fail to make a COBRA payment on or before the end of the grace period, you will lose COBRA coverage. Also, certain types of benefits may not be available on the Marketplace such as dental, vision, EAP. If you have these benefits, you may continue these benefits through COBRA, unless your dental, vision, EAP plan is bundled with the medical plan and you drop your COBRA medical plan. Go to www.healthcare.gov for more information. See the next question and answer as well.
What happens at the end of my COBRA coverage (at the end of 18, 29 or 36 months)? Can I enroll in a Marketplace health plan at that time?
According to the government rules, once you exhaust COBRA, meaning you have been on COBRA benefits for 18, 29 or 36 months, you can enroll in your state’s Marketplace. After you exhaust COBRA, you have 60 days to select a Marketplace health plan. You should go to www.healthcare.gov for more information.
Less...