COBRA: Eligibility and Enrollment

What is required to sign up for health insurance under COBRA?

Fortunately, not much.

As long as your employer had a group health plan for 20 or more employees, you can sign up for COBRA.  COBRA is also available if you are a member of an employee organization (e.g. a union), or if you work for the government.

It does not matter if you quit or were laid off, or whether you were working part-time or full-time.  Timing is important, however.  To enroll in COBRA, you must elect coverage within 60 days of your departure from your former employer.

How do I enroll?

Enrollment is a matter of filling out an application form that should be provided by your former employer when you leave.  If you were previously covered under your employer’s health plan and have not received information about COBRA, contact your human resources or benefits manager immediately.

The 60 day window

One other helpful feature about COBRA is that the coverage is retroactive.  In other words, if you haven’t yet signed up for COBRA, you can still be covered by your old insurance plan by electing to sign up for COBRA within the 60 day window.

As an example, let’s say you leave your current employer and find another job that will offer you health coverage, but the new job doesn’t start for 45 days.  Then, two weeks after you leave your previous job, you require hospitalization.   You can still be covered by your health insurance plan, as long as you are within the 60 day window.  (Note:  You will also generally be covered under your employer’s plan through the end of the month during which your employment ends.)

The 60 day window for COBRA works to your benefit.  It enables you to search for alternative health coverage during that time period, without the risk of going without health insurance.  If you don’t find a better alternative, you can always sign up for COBRA.

COBRA: Description and Overview

It’s not a snake, but its high cost can make it feel like one!

COBRA stands for the Consolidated Omnibus Budget Reconciliation Act.

It is a law that was passed by Congress in 1986.  COBRA provides you the option to continue your current healthcare plan (i.e. your former employer’s group health insurance) at the group rate that your former employer pays.  COBRA enables you to continue to go to the same doctors, receive the same prescriptions, and be treated at the same hospitals you’re accustomed to.

The most important feature of COBRA is that if you have a pre-existing medical condition (e.g. diabetes) you do not have to worry about qualifying for a new plan.

In addition, because of the tremendous variety in health coverage options, COBRA provides the ease of having access to plan that you are already familiar with, saving you the time of evaluating and enrolling in a new health insurance plan.

According to various surveys, anywhere between 25% and 50% of people who are eligible for COBRA sign up under the plan.  COBRA coverage generally lasts for 18 months, with extensions available in certain instances.

Note:  You will also be eligible for COBRA if you have had your work hours reduced to the point where your employer no longer contributes to your health insurance.

Why You Need Health Insurance

Here are three things to consider regarding health care coverage:

Probability:

Unlike nearly every other product or service that you purchase, the rationale for obtaining health insurance is not necessarily to extract value from the service that you are purchasing, but rather to protect against low probability events.

No matter how stellar your current health condition, it is impossible for anyone to predict with clarity the likelihood of needing an expensive medical procedure at some point in the future.

Lack of Preventive Care:

Data indicates that uninsured individuals are more likely to experience health problems because of a lack of preventive care. When you are paying 100% of your own medical costs, there is a tendency to postpone various routine screening treatment, e.g. annual physicals, which can result in medical issues going undetected.

Note: You can argue that if you are self insured you are more likely to take care of yourself and seek help when there are early warning signs, but in practice this is rarely the case.

A Gap in Coverage:

Federal law in the United States considers someone who goes without health insurance for more than 63 days to have a “gap in coverage.” Consequently, insurance regulators allow insurance companies to discriminate against people who have had their health insurance coverage lapse.

If you sign up for a group health insurance policy with a new employer, the insurance company will have the right to exclude coverage of any pre-existing conditions for up to a year.

In addition, if you have been without health coverage for more than 63 days and apply for individual coverage, insurance companies may refuse to cover your pre-existing conditions, or may choose to not cover you at all!