by robo70 » Sat May 15, 2010 06:37 pm
My marriage ended 3-26-2010. My ex-spouse cancelled my coverage effective 4-1-2010. I had surgery on 4-2 and now have a huge bill. I was never notified by the company OR my ex. Needless to say, I got a huge surprise when the bill came. In california I thought there was a grace period after divorce and/or COBRA. The insurance co wont talk to me as I am not the principle subscriber. Any suggestions?
Posted: Sat May 15, 2010 06:56 pm Post Subject:
There is a "grace period" -- it is the 60 days you have to enroll for coverage under the former group insurance plan by completing the paperwork and paying 100% (up to 102%) of the individual premium to the employer that sponsors the plan under Federal COBRA continuation.
If you were covered under your wife's group medical insurance, and the plan is subject to Federal COBRA continuation (20 or more full-time employees or equivalent), you have 60 days from 3-26-2010 to file for continuation of the group plan AT YOUR EXPENSE. Federal COBRA in the event of a divorce allows you to continue the group plan coverage at the full group rate for up to 36 months.
You still have a few days remaining to do that, but only a few! You'll have to contact the employer's HR department for the premium details and paperwork, but coverage would be continuous from the date of termination as soon as you pay the full two months' premium, and possibly the next month's also, and your surgery claim should be covered (unless the procedure is excluded).
You were supposed to have received a HIPAA Certificate of Creditable Coverage as well as notification of your continuation privilege under COBRA immediately following your termination from the plan (within 45 days, which is . . . today). If you never received either, your wife's employer or their Third Party Administrator (TPA) could actually be held liable for your "damages" for failure to comply with federal law regarding timely delivery of the required notices to you. That's another matter.
If the plan was not subject to Federal COBRA, there is also something known as Cal-COBRA which operates under essentially the same rules. Again, there are required notices and if you did not receive them, you could be in a good position to press for them to pay your damages. You can be charged a larger percentage of the premium (up to 150%), but you cannot be denied coverage if you apply within the time limit.
Make the necessary phone calls on MONDAY MORNING, 8am!!
Posted: Sat May 15, 2010 11:22 pm Post Subject:
that is the problem when we don't know these things. we are always caught on surprise and then it is too late.. hopefully it wasn;t for you maxherr
Posted: Sun May 16, 2010 03:39 am Post Subject:
This is exactly the reason folks need to develop a relationship with an insurance professional, just like they do with doctors, dentists, accountants, and mechanics.
Any good insurance professional should be in a position to give advice on things like COBRA, HIPAA, ERISA, and EGTRRA that's about to expire.
If you have a problem with your car, you don't ask your family physician to diagnose what's wrong. If your head hurts, you don't ask your car mechanic to take a look at it. We rely on these experts in our lives to help us in their areas of expertise. To have an insurance question and not know who or where to go for an answer can be harmful, because your financial situation is at risk.
So maybe we should have a new thread on COBRA and HIPAA. I think I might just start one!
Posted: Sun May 16, 2010 05:28 pm Post Subject: dropped like a hot rock
Thank you all for the info. Am following up tomorrow with the employer.
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