COBRA Participant Toolkit

What is COBRA?

Under certain circumstances, your employer is required to offer you and/or your dependents who are covered on your health benefits continuation of coverage when you would otherwise lose your insurance.

Federal law requires most group health plans to offer employees and their covered family members the opportunity to continue their health care coverage when there is a "qualifying event" that would result in a loss of coverage under an employer's plan.

"Group Health" plans are medical, dental, vision, the Health Care Flexible Spending Account, and some Employee Assistance Programs (EAP's)

Each family member who elects continuation coverage will have the same rights as Plan participants, including open enrollment and special enrollment rights.

Different qualifying events have different requirements for reporting them to your employer. They also vary in the maximum length of time for which COBRA applies.



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 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.
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.