COBRA Participant Toolkit

Choices and Alternatives Chart

If

Then

Additional Thoughts

You decide to let your insurance expire and take your chances You are making one of the most unwise decisions you will probably ever make in your life. You could easily find yourself financially ruined if something were to happen to you while you are uninsured.

You can review alternative coverage options at GetInsured.com and  healthcare.gov

Your family's income falls to the point that you may meet income tests for state assistance Explore any government plans that might be available to you. For instance, your children might now be eligible for insurance under the State Children's Health Insurance Program (SCHIP). You can cover yourself and spouse through COBRA (or another option) and children through SCHIP if you qualify.
You have insurance available through a spouse's plan, even if it's not as good as yours. Unless you have a major health condition whose treatment would be severely disrupted by changing plans, evaluate your spouse's plan carefully. It may be more cost-effective for you to have your spouse cover you (and any dependent children) on his/her plan, even if just for a short period of time while you are between jobs. Check your spouse's plan's network to see if you will need to change doctors. Only you can weigh the costs and benefits of your spouse's benefit plans vs. COBRA.
You know well in advance that you will be losing coverage, and know that COBRA premiums are going to be too expensive for you.

Investigate individual plans. TRI-AD has a partnership with GetInsured.com, where you can find and compare health and dental policies from the major insurers as well as those available through the Marketplace (public exchanges on healthcare.gov). GetInsured.com also shows you if you are eligible for a subsidy/tax credit.

There are also various other websites that provide coverage information.

Your analysis is a cost-benefit analysis: the tradeoff is between self-insuring a portion (through a higher deductible) vs. lower monthly premiums. Generally, the higher your deductible, the lower your premium. Look at your health use history. If you don't use many services, consider a higher-deductible plan. If you need a lot of health care, consider a lower-deductible plan, an HMO, or COBRA coverage.
One of your family members has a health condition requiring ongoing treatment. The rest of you are in good health. Investigate individual plans, especially for the healthy family members. TRI-AD has a partnership with GetInsured.com, where you can research and purchase health and dental coverage from the major insurers and through the healthcare.gov Marketplaces (public exchanges). You can consider splitting your family's coverage to cover some of you under less-costly individual plans and the less-insurable person under COBRA. Consider taking COBRA, or at least enrolling before the 60-day window to enroll ends, so that you keep your options open as you are applying for individual coverage. Remember, your COBRA coverage is not reinstated until you actually pay, and you have 45 days from the date you elect COBRA to make your initial payment.
You are expecting a baby You need health insurance more than at pretty much any other time in your life. Research your options, including COBRA, and secure coverage. Remember, after the baby is born you need to alert the Plan Administrator to add the baby to the insurance. It will not automatically happen.
You are leaving work due to HIV-related issues or end-stage renal disease The government may pay your COBRA premiums for you. See your COBRA enrollment materials for more details.
You have a balance left in your health care Flexible Spending Account when you lose coverage You can elect COBRA for your FSA and send in after-tax payments. Once you have used up your balance, you can stop making the contributions. Look back through your records and claim everything you can that you haven't already claimed. The sooner you use up your balance, the sooner you can drop the FSA COBRA coverage.
Your wife is in the middle of having a crown done You can elect dental coverage and keep it for just for a short period of time. For example, you could elect dental coverage for yourself and your spouse, have all your dental work done, and then stop paying for dental after a couple of months. You would not be able to re-elect dental coverage until open enrollment.

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 Dept.
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.
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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.
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