COBRA Administrationrhs.org/wp-content/uploads/2014/07/2623-RHS_COBRA_admin-1.pdf · This notice...

Redwood Health Services

Scope of Included Services

After the Implementation process has been completed, the RHS COBRA Administrator handles ongoing COBRA services. The following is a comprehensive overview of COBRA services

provided by RHS, as well as the Client’s and the Qualified Beneficiary’s responsibilities in the process.

•OnanongoingbasisandonaschedulemutuallyagreedtobyRHSandtheClient,theClientprovidesinformationtoRHSonallemployeesand/orfamilymemberseligibleforCOBRAContinuationCoverage.EmployermustcompleteandsubmitviamailorfaxaQualifiedEventFormprovidedbytheRHSCOBRAAdministratortoRHS,showingqualifiedbeneficiary,qualifyingeventdate,andcurrentbenefitinformation.

•RHSenterstheQualifiedBeneficiaryDataFormintotheRHSCOBRAdatabase.

•RHScreatesandmailstheCOBRAQualifyingEventNoticetotheQualifiedBeneficiarieshomeaddressviaU.S.P.S.certificationofmailingwithin14daysofreceiptoftheQualifiedBeneficiaryDataFormfromtheClient.ThisnoticeinformstheQualifiedBeneficiaryoftheiroptiontoselectCOBRAcoverage,thecostsinvolved,andthelastdayforelectingCOBRAcoverage.Thecertificateofcreditablecoveragewillalsobeincludedinthispacket.

•RHSincludestherequiredMedi-CalNoticeintheQualifyingEventPacketforallQualifiedBeneficiariesresidingintheStateofCalifornia.

•TheQualifiedBeneficiaryhas60daysfromthedatethenoticewasgeneratedorfromthedatethecoveragewaslost,whicheverisgreater,torespondtothisnoticeandelectCOBRAcoverage.ToelectCOBRAcontinuationcoverage,theQualifiedBeneficiarymustreturnasignedelectionformtoRHSpostmarkedwithinthe60-daywindow.

•IfRHSdoesnotreceiveasignedelectionformfromtheQualifiedBeneficiarywithinthe60days,thisconstitutesbydefaultadecisionbytheQualifiedBeneficiarynottoelectCOBRAcoverageandtheoptiontoenrollinCOBRAisnolongeravailable.

•IftheQualifiedBeneficiaryrespondsandelectstheCOBRAcoveragewithinthe60-day

windowofopportunity,theQualifiedBeneficiaryhas45daysfromthedatetheysignedtheelectionformtomakeallpremiumpaymentsnecessarytobringtheiraccountup-to-date.

•Uponreceiptoftheelectionformandpremiumpayment,RHSsendstheQualifiedBeneficiaryasetofpaymentcouponsforthecurrentPlanyearviaU.S.P.S.firstclassmail.ThecouponsindicatetheCOBRApremiumdueeachmonth,wherethepremiummustbesent,andthedateeachpaymentisdue.

COBRA Administration

Redwood Health Services

•Oncetheinitialpremiumpaymenthasbeenreceived,RHSinformstheappropriatecarriersviafacsimilethattheQualifiedBeneficiaryhaselectedCOBRA,paidthepremiumandneedstobereinstatedinthePlan.

•TheQualifiedBeneficiary’spremiumpaymentsareduebythefirstofthemonthforthecurrentmonth’scoverage.EachQualifiedBeneficiaryisgivena30-daygraceperiodinwhichtohavehisorherpaymentpostmarked.AnypaymentsforwardedbeyondthegraceperiodarereturnedtotheQualifiedBeneficiarywithaTerminationNoticeviaU.S.P.S.firstclassmail.AnyQualifiedBeneficiarythatfailstomaketheappropriatepremiumpaymentinatimelymanneristerminatedfromtheCOBRAPlan.

•InsufficientfundsdonotconstitutepaymentandmayresultinterminationoftheQualifiedBeneficiary’sCOBRAcoverage.RHSmailsanInsufficientFundsNoticeviaU.S.P.S.firstclassmailinformingtheQualifiedBeneficiarythattheymaybeterminatediftheyfailtoprovideanewcheckormoneyordertoRHSwithinthestandardgraceperiod.RHSchargestheQualifiedBeneficiaryaNSFfeeforeachcheckthatresultsfrominsufficientfunds.TheNSFfeemustbeincludedintheQualifiedBeneficiary’spaymentortheQualifiedBeneficiaryisterminatedfromtheCOBRAPlan.

•WhenRHSreceivesthemonthlyCOBRApremiumpaymentsfromtheQualifiedBeneficiary,thecheckisprocessedthroughtheRHSFinanceDepartment,andacheckispreparedandmaileddirectlytotheClientfortheQualifiedBeneficiary’sreimbursementofthecarrierCOBRApremium.

•RHSproducesandsendstotheClientamonthlybillingstatementreflectingtheCOBRAAdministrativeServicesforthemonth(i.e.,perPEPMFee,COBRANotificationPacketssent,OpenEnrollmentPacketssent).

•RHSnotifiestheClientofanyCOBRAQualifiedBeneficiary’sterminationofcoverage.

•RHSmailsanEndofEligibilityNoticeapproximately60daysbeforetheQualifiedBeneficiaryreachestheendoftheirCOBRAeligibilityperiodinformingthemthattheymay,ifthecarrierallows,havetheoptiontoconverttoanIndividualPlanthroughtheircarrier.ThisnoticeissenttotheirhomeaddressviaU.S.P.S.firstclassmail.

•QualifiedBeneficiary’swithquestionsand/orissueswillcontacttheRHSCOBRAAdministratordirectlyatthenumberprovidedinthedocuments.QualifiedBeneficiary’swithfamilystatuschangesthatmayaffectCOBRAcoverageshouldcontacttheClientortheRHSCOBRAAdministrator.

•RHSwillmaintainhistoricalfilesoneachCOBRAQualifiedBeneficiaryforaseven-yearperiod.

Reinstatement of COBRA Qualified BeneficiaryThisallowstheClienttoreinstateaCOBRAQualifiedBeneficiarythathaspreviouslybeen

terminated.RHSdoesnotrecommendthatexceptionsbemade;however,weunderstandthattheClientmayfeelitisnecessaryincertainsituations.RHSmustreceivepermissioninwritingfromtheClienttoprocessthereinstatementandconfirmationfromthecarrieraswell.

Enrollment under COBRAOnceaninitialCOBRApremiumpaymenthasbeenreceived,RHSinformstheappropriatecarriers

viafacsimilethattheQualifiedBeneficiaryhaselectedCOBRA,paidthepremiumandneedstobereinstatedintheelectedplan.

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Redwood Health Services

California Insurance Code Section 10116.5 Administration (Ins. 10116.5)Ins.10116.5allowsCaliforniaStateresidentsoverage60therightundercertaincircumstancesto

continuethemedicalportionoftheirCOBRAcoverageelectionuntiltheyreachage65.Clientscanelect,foradditionalfees,administrationofthiscontinuationofcoveragefortheQualifiedBeneficiary’swhomeetthecriteriasetforthintheGeneralProvisionoftheInsuranceCode.

Open Enrollment ServicesUnderCOBRAlaws,whentheClientholdsOpenEnrollmentforitsactiveemployees,

COBRAQualifiedBeneficiary’smustbeaffordedthesamechoicesthatactiveemployeeshavetheoptiontoexercise.COBRAQualifiedBeneficiary’sarealsoaffectedbyanyratechangesintheClient’sprogram.RHSmustnotifyallCOBRAQualifiedBeneficiary’sby‘SpecialNotification’atleast30dayspriortothesechanges.AllchangesarebasedontheinformationtheClientprovidestoRHS.

HIPAA Certificates of Creditable Coverage:TheCertificateisincludedintheCOBRAserviceslistedaboveatnoadditionalcharge.

Note:TheCertificateofCreditableCoverageisprovidedatthetimeofthe‘qualifyingevent’notificationandatterminationofCOBRAcontinuationofbenefitcoverage.

Below is a list of other COBRA documents provided in the services listed above as necessary and at no (additional charge):EnrollmentConfirmationNoticeIncompleteEnrollmentDeficientPaymentNon-CommencementLatePaymentNoticeTermNotice–ConversionOpenEnrollmentLetterCouponCoverLetterPremiumNoticeCouponsReinstatementPendingTerminationLetterforCADependentNotificationLetterCoverageConfirmationCoverageConfirmation(Spouse)EnrollmentConfirmationAutomaticTerminationNoticeChangeofAddress

PremiumRateChangeEligibilityConfirmationDenialofCoverageCoverageTakeoverUSERRAElectionNoticeMedicarePartDCreditableMedicarePartDNon-CreditableStateContinuationNoticeTerminationConfirmationReinstatement–EnrolledEnrollmentFormReceivedReturnedCheckNoticeMedicareEntitlementNoticeSocialSecurityEligibilityNoticeDisabilityRateNoticeLeaveTerminationNoticeARRANotifications

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Contact Redwood Health Services

©Redwood Health Services. All rights reserved. 2623 0316

COBRA AdministratorBarbara CannonPhone: 707-525-4292Fax: 707-525-4398bcannon@rhs.org

FinanceRon BurtonPhone: 707-525-4269Fax: 707-525-4398rburton@rhs.org

Sales and AdministrationJohn Nacol, CPA, CEOLicense: OD88299Phone: 707-525-4370Fax: 707-525-4270jnacol@rhs.org

Director of ClaimsSandy SylversPhone: 707-525-4209Fax: 707-525-4223ssylvers@rhs.org

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Corporate Headquarters3510 Unocal Pl. #108Santa Rosa, CA 95403Toll-free: 800-548-7677Fax: 707-525-4270

Regional Office Orange & San Diego Counties Phone: 949-878-0209

Regional Office Sacramento & Northern Counties Phone: 530-953-8225

Customer ServiceToll-Free: 800-548-7677, option 2Local: 707-544-2010, option 2Fax: 707-525-4311kpass@rhs.org