Tag: continuation coverage

TPA Faces ERISA Benefits Denial Claim for Improperly Raising COBRA Premium

A third-party administrator that poorly communicated a COBRA premium rate increase ­— which in any case was likely prohibited under COBRA’s rules — is being sued for ERISA benefits denial and state-law promissory estoppel claims. The TPA instituted the premium change but did not provide clear written notice of it as required under plan terms. […]

Here’s How Heimeshoff Could Affect COBRA Limitations Periods

By Paul Hamburger, Esq. A recent U.S. Supreme Court decision held that a plan’s contractual limitations provision is enforceable. It just has to be of reasonable length and not conflict with a “controlling” statute. The case is Heimeshoff v. Hartford Life & Accident Insurance Co. et al., No. 12-729 (S. Ct. Dec. 16, 2013). A number of […]

Agencies Would Broaden Exceptions to Required Benefits

Employee assistance programs and certain “limited wraparound coverage” would be added to the set of “limited excepted benefits” exempt from most of the requirements of the Affordable Care Act, under proposed rules in the Dec. 24 Federal Register (78 Fed. Reg. 77632). The proposal also would make it easier for dental and vision benefits to […]

Taking COBRA or Exchange Coverage: Impact on the Health Care Reform Subsidy

Earlier this month, health insurance exchanges (also known as marketplaces) under the Affordable Care Act were launched, giving consumers — including COBRA qualified beneficiaries — new coverage options. Because qualified beneficiaries may come to employers with questions about enrolling in COBRA versus exchange coverage, here are some key issues to keep in mind. The key […]

Bad Press for Ending COBRA Due to 26 Cents Premium Shortfall Shows Need to Know the Rules

COBRA’s premium payment rules took center stage Aug. 12, when the “Bamboozled” column in the New Jersey Star-Ledger reported that a qualified beneficiary with leukemia had his coverage terminated early because his premium payment was 26 cents short. The story had a happy ending, but employers and their service providers can avoid being the villains […]

Employer’s Negligence Results in $1.85 Million COBRA Notice Penalty

A large employer was socked with $1.85 million in COBRA notice penalties, plus still-to-be determined attorney’s fees, for neglecting its duty as plan administrator to ensure that COBRA election notices were sent on a timely basis. The company’s negligence occurred over several years, affecting hundreds of former employees who participated in a class action lawsuit. […]

Employer Says Gross Misconduct Means No COBRA Coverage for Ex-employee

An employer provided enough evidence raising questions of a former employee’s possible gross misconduct to ward off her summary judgment motion regarding a COBRA notice claim. The employer noted the individual had committed gross misconduct by quitting the job without notice, refusing to follow supervisor instructions and initially lying about why she left work early […]

DOL Issues Model Notice/Guidance on Exchange Options, also Updates COBRA Election Notice

Employers wanting to get an early start on providing a required notice to employees of coverage options under health insurance exchanges just got some help from the federal government. On May 8, the U.S. Department of Labor issued a model notice for employers may use now — but must use beginning Oct. 1, 2013. The […]

$1.3M Settlement in COBRA/ARRA Class Action Now Final

On April 23, a federal district court in Alabama gave final approval to a settlement agreement under which an employer and plan administrator will pay $1.3 million to a group of former employees who alleged they never received COBRA election or premium subsidy information after their involuntary termination of employment.  The case is Hornsby v. […]

COBRA Extension Notice Needed Despite Awareness of Disability

Group health plan terms clearly explained that the plan administrator had to be notified of a disability determination within 60 days in order to trigger an 11-month COBRA extension; therefore, the plan administrator was justified in denying the extension when notice was received five months after the determination was issued, a federal district court in […]