Practical HR Tips, News & Advice. Updated Daily.
An employer whose COBRA/leave policy did not align with a stop-loss policy’s terms continues to be on the hook for a COBRA qualified beneficiary’s medical claims that were rejected by the stop-loss insurer. The employer unsuccessfully appealed a lower court ruling that the claims were ineligible under the policy terms because they did not include […]
A former employee’s failed attempt to call COBRA coverage a “privately paid” policy, rather than an ERISA plan, in order to maintain state-law claims against a group health insurer offers a chance to remind employers about importance of knowing the legal status of their benefit plans. In the case, the individual sued the insurer for […]
The failure to administer COBRA continuation coverage notices correctly can cost employers and plan administrators money, time and aggravation, says COBRA expert Paul M. Hamburger, Esq. of Proskauer Rose LLP. He provides four tips they can use to help avoid COBRA notice missteps: (1) prepare clear, accurate and complete COBRA notices; (2) be sure to […]
Here’s one positive pattern in COBRA coverage lawsuits: Even if a plan administrator violated the COBRA law, if it acts reasonably under the circumstances, courts are inclined to mitigate the amount of any penalties. But even though the law is more than 25 years old, case law shows there’s still a learning curve about its […]
New guidance on a group health coverage reporting requirement raises some important issues regarding COBRA coverage and provides a silver lining for employers, who should be able to use their current COBRA premiums to determine the reportable cost of health coverage — making the new burden of this requirement a little easier to bear, according […]
Postcards are designed to provide a brief message, but it will be interesting to learn if such brevity is sufficient to adequately notify an individual of COBRA continuation coverage rights — particularly when the law identifies at least 14 content requirements for COBRA election notices. In a recent court case, an employer/plan administrator faced with […]
A recent court case highlights two crucial issues in administering COBRA continuation coverage: (1) a plan administrator has the sole legal obligation to prove compliance with COBRA’s notice rules — it cannot pass the buck to third-party administrators; and (2) lack of sufficient evidence on COBRA notice procedures can be a costly mistake. Recently, an […]
An important component of health reform implementation is the imposition of an “essential benefits” package (of health goods and services that insurers of groups and individuals must cover). Under the Patient Protection and Affordable Care Act (PPACA), that benefit package will be de rigueur (1) for policies sold on exchanges and (2) insurers of small […]
One simple line requiring that group health plans and insurers describe “continuation of coverage provisions” in summaries of benefits and coverage (SBCs) actually raises several complex issues for COBRA administrators. The health care reform law requires that group health plans and insurers accurately describe in SBCs the benefits and coverage under the applicable plan or […]
To fill in the knowledge gaps on how many individuals enrolled in the COBRA premium subsidy program — data that will be helpful in determining the program’s cost-effectiveness, who best benefited from the subsidy and how to target similar programs — the U.S. Department of Labor (DOL) plans to sponsor a study sometime in 2012. […]