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COBRA Explained

This is a continuation of last week’s column about health insurance at divorce.


Because of the far-reaching economic implications upon husband, wife, and children, planning to assure appropriate health insurance coverage at divorce or separation should not become an adversarial issue.


“COBRA” is an acronym for Consolidated Omnibus Budget Reconciliation Act of 1985, a federal law enacted to stop health coverage lapses for "beneficiaries" that otherwise resulted when certain "qualifying events" occurred.


In the matrimonial arena, we are concerned with only two types of "beneficiaries" -- 1) non-employee spouses and 2) dependent children -- and only two types of "qualifying events" -- 1) divorce or legal separation and 2) A dependent child ceasing to be a dependent under the terms of the employer's health plan.


Generally speaking, to be required to offer continuing coverage to these beneficiaries at these qualifying events, an employer must provide a group health plan for more than 20 employees. If this is the case, coverage can continue so long as the non-employee spouse or adult child 1) properly exercises an election to continue coverage within certain time limits, 2) timely pays the first premium, and 3) continues to pay premiums in a timely fashion to the employer. Remember: When you make the COBRA election, you don't deal with the insurance company; you deal with your former spouse's employer. It is important to remember that employers who provided health plans to less than 20 qualifying employees during the prior year are not subject to COBRA requirements.


So long as these rules are complied with, continuation coverage is effective retroactively to the date of the divorce or separation and will continue for a maximum period of 36 months. The maximum continuation cost to the beneficiary is 102% of premium unless the employer is self-insured. There are no new eligibility requirements or waiting periods to contend with; but, as you will soon see, there may be drawbacks to COBRA. That's why you should explore your other options, if any, before you make a final health insurance decision.


There is no question that, in some instances, COBRA can be a lifesaver -- such as when a spouse or child has a preexisting condition which would disqualify that person from getting other coverage; however, if the person faced with making the election is healthy, there may be other options that will better fit that person's long-range best health insurance interests.


But there are drawbacks: Claims information about your personal health problems will continue to be available to your former spouse's employer. When you need claims forms, you will have to get them from your former spouse's employer. And, in some instances, reimbursement checks from the insurance company may be made payable to your former spouse. If these and other issues are not addressed -- and solved -- at the time of divorce or separation, you may find yourself back in court trying to solve them later.


Many people wait until the last minute when their options are limited. In making health insurance decisions, it's best to take a two-step approach as early in the process as possible:


First, compare coverage and cost between the current benefits of COBRA continuation, an individual policy (if available), and any conversion possibilities that might exist for you.


Then, if you have the time, inquire into all of the important issues before you decide to either elect COBRA continuation or seek other coverage.


Next Week: More about health insurance coverage at divorce.



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