Group Health Insurance Continued
Mini-COBRA
Recall the discussion of COBRA from chapter 24 - we said it is a federal law that demands that an insurer covering a group of 20 or more employees offer a continuation of the group plan at the group rate should an employee leave for any reason other than gross misconduct.
Here we will discuss "miniCOBRA", which is the Florida law version of COBRA for group health plans covering less than 20 employees. It is still a continuation of the group plan at the group rate should the employee leave for any reason other than gross misconduct.
Continuation ****
The Florida Health Insurance Coverage Continuation Act ("Mini-COBRA") ensures continued access to the group plan at the group rate (generally) for employees of groups of less than 20 employees if any of the employees leave the group for any reason other than gross misconduct.
Definitions
Small employer - fewer than 20 employees.
Group health plan is any small employer health plan that pays benefits for current or former employees and their dependents.
Qualified beneficiary is any employee, spouse or child who, on the day before the qualifying event for the covered employee, is covered under the group health plan.
Qualifying event means any of the following events that would result in a loss of coverage:
- The death of the covered employee;
- The termination of employment (not gross misconduct);
- The divorce of the covered employee from the covered employee's spouse; or
- A dependent child ceasing to be a dependent child.
Continuation of coverage under group health plans ****
If a person experiences a qualifying event that would result in loss of coverage under the group plan, then that person is entitled to elect "miniCOBRA" without evidence of insurability if written notice is given within 63 days of the qualifying event. Within 14 days after the receipt of the qualified beneficiary's written notice, the insurance carrier shall send each qualified beneficiary by certified mail an election and premium notice form.
Of course, for the individual to receive the continuation of coverage the initial premium must be paid and election of continuation must be made in writing to the insurance carrier within 30 days after receiving notice from the insurance carrier. Coverage and premium due will be retroactively to the date coverage would otherwise have terminated.
After the election, the insurance carrier must bill the qualified beneficiary monthly, with a premium due date on the first of the month and allowing a 30-day grace period. The premium paid for continuation of coverage may not exceed 115% of the applicable group premium during the first 18 months of coverage. If the person was disabled and eligible for Social Security Disability benefits at the time of the qualifying event, then they can elect an 11-month extension during which the insurance company can charge 150% of the group premium rate.
Coverage under the group health plan must, at a minimum, begin on the date of the qualifying event and end when one of the following happens first:
- 18 months passes (similar to COBRA);
- The date on which coverage lapses from nonpayment of premium;
- The date the beneficiary becomes covered under any other group health plan, (i.e., you got another job);
- The date a qualified beneficiary is entitled to benefits under either Medicare part A or part B **note: This applies to Florida's Mini-COBRA, not Federal COBRA, as learned in chapter 24. In other words, Mini-COBRA (Florida) eligibility would stop when the person is eligible for Medicare, but eligibility for Federal COBRA (employers with 20 or more employees) would actually extend eligibility for COBRA to 36 months.