11 replies to this topic

[TroyLynn]

Well, my work being the charming bullies they are put me on medical leave for a year as retaliatory measure  (very long story, I have contacted the EEOC, and they are investigating several concerns in regards to my employer), my husband had a co-worker approach him claiming her undying love for him (yes, she knew he was married, with 4 daughters, and a wife who has cancer....this for some reason didn't stop her....being a lady I will refrain from further comment) her advances made work extremely uncomfortable for my  husband so on our 28th wedding anniversary with my blessing he quit, his job had our insurance.  My husband has already had some job offers but we will be on COBRA for at least 3 months, and I get to have my 4th bmb next month and maybe a drug switch.  I could use any wisdom anyone would like to share, I have found a wealth of wisdom on this forum and I am really grateful you are all here.

[TroyLynn]

let me rephrase...I am not glad everyone here has CML, I am glad you all are so helpful, and everyone has been very nice, thanks

[misskitkat]

What is your question -- is it should you continue your insurance under COBRA or something else?

[CallMeLucky]

Under COBRA, nothing should change from where it was before he left the company, the only difference is that you should be paying a higher monthly premium for the coverage since the employer is not paying their portion and you are taking on the full payment.

Now the one thing you should check to make sure is that they don't reset your deductibles.  I could envision where they might try to say it is a "new" policy and therefore deductibles reset.  This should not be the case and I would hope it is illegal for them to do that and they won't do that, but you should check.  To be prudent just call them, tell them when the COBRA date is effective and ask them if anything changes with coverage, the answer should be no.

[TroyLynn]

Thank you, my husband's last day was November 10th, we haven't received any paperwork for COBRA, I have no experience being unemployed or uninsured and I am only a year into my CML journey.  Is it up to the employer or us to initiate COBRA coverage?  It would be a blessing to relocate to an area with more medical options, in the heart of Wyoming, I am very limited that way (my oncologist is 300+ miles away) and I would love to get into a graduate degree program maybe even law school, I figure if I am going to have an expensive drug habit (I have no experience with that either, I feel like such a greenie) I better make it so I can earn more money, I feel a door has been closed and a large window opened...it is just navigating to the window seems a little daunting at present.  Thanks for your help.

[misskitkat]

You need to contact the HR department at your husband's former employer ASAP. The forms have to be returned with the first month's premium within a certain period of time (30 days? Not sure about that).  Not sure if you have a PPO or HMO, but if you have either of these, you need to check to see if the providers in the state you want to move to will still be "in network".

[TomL]

Your COBRA benefits will go back to his last day of employment. It usually takes the COBRA administrator several weeks (they actually have 14 days to MAIL the COBRA letter. Once you get the actual billing statement, you make the election to take COBRA (i.e., continued benefits) and you have 60 days from the date of termination to make the first payment. Your coverage starts the day of termination (effective date), your coverage (once you elect and pay the premium) is from that date. Any medical expenses you incur during the period from the effective date to the day the insurance "goes back in to effect" (that is, when the insurance company tells providers you have insurance) will be reimbursed to you by the insurance company. Most companies, large and small, use an outside COBRA administrator. The former employer has nothing to do with the coverage from that point on OTHER THAN they are still in control of the actual health insurance policies in effect. You should NOT have your deductibles re-set, other than those weeks where the insurer reports no coverage to the provider, it is just as if you never had a lapse in coverage. You will always have 60 days to make a premium payment before being cancelled BUT the provider can put you back into the "reporting as no insurance active" mode when you are not paid up-to-date. USUALLY there is not a problem with a few days with most of the medical carriers, but the dental and eye carriers are notorious for stopping coverage the day after a premium is due.

You as the wife, and your family that was covered prior to termination have you own COBRA benefit and rights. In other words, you can elect COBRA coverage and your husband can opt out and you can still have coverage. Lets say for instance that your husband gets another job and for one reason or another it is beneficial for him to switch to other coverage (either another group plan or an individual plan). YOU still have the right to stay on the COBRA coverage for the full 18 months.

You husband may want to insure that when he makes his unemployment claim that he uses the unacceptable working conditions and has the unemployment dept treat it as if it was an involuntary separation. You could have a situation where you can effectively claim involuntary separation and qualify for the federal COBRA subsidy if it was in effect when he terminated or if it is re-instated at some point retroactively.

I hope this helps. I am sure you will receive many comments finding fault with my statements.

[misskitkat]

I'm sure that those are the facts, but I still would not wait for the company to send you a letter, I would call HR and get things moving. They should be able to tell you right away what the premiums will be for single and family covereage. Then you can check out other insurance options, especially for your husband if he qualifies.

[misskitkat]

I forgot to add in my post that I believe that COBRA only applies to companies with 20 or more employees.

[TroyLynn]

This is all very helpful TomL, misskitkat, everyone thank you.

[TomL]

The way the law reads it is 20 employees ADJUSTED for part-time employees as of the PREVIOUS calendar year. There is a formula to use that adjust the part time employees to equivalent full time employees. It is another case of the federal laws making absolutely no sense. How they can "compute" equivalent employees using part-time who are not even eligible for benefits in the calculation for COBRA compliance makes no more sense than most of our tax and other labor laws. But that is the way it is. I know of one company that has 8 full time employees that must pay the enormous costs of compliance with COBRA because of their part-time employees. Go figure. Also, in this recession there are companies who have had to have reductions in employees and are still having to maintain COBRA compliance because LAST year they had enough employees to qualify. I am going to have to research what happens when the recession is finally over and they build their workforce back up.

[TomL]

BTW, you are in the same position I am in, with CML,. I have few other choices. But luckily I have the VA to fall back on. When the federal subsidy runs out (65% of total COBRA premium), I will have to go full time with VA and my wife will probably stay on the COBRA until she goes on Medicare. She has some health issues as well, so her alternative health insurance options are limited.

Your husband may have the option of a short-term medical plan to take care of the short run, but that option is NOT credible coverage. In other words, even if he goes on another group plan any pre-existing condition will not carry over to the new plan. He can have a lapse of up to 63 days from one credible coverage to the next. See the link at http://www.dol.gov/e...umer_hipaa.html for information on HIPPA laws. Not only is short-term medical not credible coverage for carryover to new plans, it does not cover pre-existing conditions, usually defined as up to 5 years depending on your state. PLUS, it is not guaranteed renewable, so when the policy expires in 6 or 12 months, any condition you acquired during that coverage is now a pre-existing conditon for the NEXT policy and not covered.

I really hope this all helps you, I know you are going through a tough time. It is funny how these companies can find a legal reason to terminate folks who develop these expensive and physically limiting conditions. Isn't it amazing how they can also make these magazine and newspaper "Best Places To Work" lists? I suppose they mean Best Place for Healthy Employees to Work.

Message was edited by: TomL