A WageWorks Company
COBRA PARTICIPANT FAQ
Participants
The Consolidated Omnibus Budget Reconciliation Act (COBRA) was passed in 1986. This is federal legislation requiring employers with 20 or more employees to offer those
who have experienced a Qualifying Event, the option to continue the group health coverage they had as an active employee.-
Planned Benefit Systems (PBS) is a third party COBRA administrator, not an insurance carrier.
We work closely with your former employer to ensure compliance with COBRA regulations and to facilitate communication among all parties.
At the most basic level, we are an intermediary between you, your former employer and the insurance carriers.
Under COBRA, the former employee and any covered dependents (also known as a Qualified Beneficiaries) are eligible to elect the same coverage that he/she had as an active
employee and/or eligible dependent. For example, if the former employee had an Aetna HMO medical plan with family level coverage, he/she and any dependents covered at the
time of the Qualifying Event would be offered the same coverage, if available, under COBRA.
Terminations (voluntary or involuntary), reduced hours, and layoffs are qualifying events affording the former employee 18 months of COBRA coverage. Divorce, legal separation,
death of the employee, Medicare Entitlement of employee, or a dependent losing status as a dependent, entitles the qualified beneficiary to 36 months of coverage.
An 11-month extension at 150% of the premium may be available to a qualified beneficiary who is deemed disabled by Social Security prior to or up to 60 days after their qualifying event. A copy of the disability certification form from the Social Security Administration must be forwarded to PBS within 60 days of the notice and prior to the end of the original 18-month continuation period. The 11-month extension may be terminated if a determination stating the individual is no longer disabled is made.
An 11-month extension at 150% of the premium may be available to a qualified beneficiary who is deemed disabled by Social Security prior to or up to 60 days after their qualifying event. A copy of the disability certification form from the Social Security Administration must be forwarded to PBS within 60 days of the notice and prior to the end of the original 18-month continuation period. The 11-month extension may be terminated if a determination stating the individual is no longer disabled is made.
Following your COBRA Qualifying Event, your former employer reports your insurance coverage termination to your insurance carriers and to PBS. PBS then sends you an enrollment
packet (enclosed). Remember, your coverage will not be reinstated unless you elect and pay for COBRA.
Generally, your insurance will not change as you are electing to continue the same coverage that you had immediately preceding your Qualifying Event. However, if the employer
group changes plans for active employees, your insurance coverage under COBRA may also be affected.
If new insurance cards are required following your reinstatement, they will be issued by the insurance carrier, not PBS. In the meantime, you should use your existing insurance cards or call the toll free member service number listed on the card for further instruction. If you are a former dependent electing under your own account, a new insurance card is typically issued by the insurance carrier(s) because the account has been created under your name.
If new insurance cards are required following your reinstatement, they will be issued by the insurance carrier, not PBS. In the meantime, you should use your existing insurance cards or call the toll free member service number listed on the card for further instruction. If you are a former dependent electing under your own account, a new insurance card is typically issued by the insurance carrier(s) because the account has been created under your name.
NO. COBRA coverage is retroactive to your first day after loss of active coverage under benefits.
You have 60 days after the date printed on your COBRA Notification letter or the date your insurance coverage (through your former employer) ends, whichever is later, to
decide whether to elect COBRA.
Complete and sign the enrollment form included in your packet. Be sure to list all covered dependents (name, date of birth, gender, and Social Security Numbers) -who are electing
continuation coverage. Once you have completed your enrollment form, mail it back to PBS. Including a check with your enrollment will expedite the process. Otherwise, you have
45 additional days from the date you signed your enrollment form to pay all retroactive premiums and bring your account up-to-date. Refer to the COBRA Coverage Continuation
Premium Summary sheet in your packet for exact amounts. Remember, we will NOT forward your enrollment application to the insurance carrier until one full month's
premium is received.
* Please include your phone number on the enrollment form where indicated. It is important that we are able to get in touch with you should we have any questions or need clarification on your selections.
* Please include your phone number on the enrollment form where indicated. It is important that we are able to get in touch with you should we have any questions or need clarification on your selections.
You may drop the plans you do not want (medical, dental and/or vision) or decrease your coverage level (e.g. from family to single) by following the instructions indicated on
the enrollment form.
After PBS receives your completed enrollment form and initial payment, we will update your information in our system and mail you a set of payment coupons. Detach the appropriate
coupon and include with your payment so we can credit your account accurately. If you are paying for multiple months, please send all payment coupons that apply even if you are
sending one check. If you do not have a coupon, please include the name of the person who is primary and former employer name on the memo line of your check. We are able to
resend coupons to you at any time if you misplace or run out of them. Feel free to contact a PBS representative at any time if you need to request a new set of coupons.
PLEASE NOTE: You MUST make timely premium payments whether you receive the coupons or not. If your payment is not postmarked by the applicable grace date, coverage will be
cancelled with no avenue for reinstatement.
Your COBRA premiums are due on the 1st of each month for that month of coverage. So, your June payment is due June 1st. However, you do have a 30-day grace
period in which your payment envelope must be postmarked. Be aware-that payments postmarked OUTSIDE the 30-day grace period will NOT be accepted and your coverage will be
terminated retroactively.
Sorry, we DO NOT accept phone payments or bank drafts at this time. All payments must be either check or money order.
Once PBS receives your completed enrollment form and at least one month's payment, we will update your information in our system (3-5 working days). Then, we send your information
to your insurance carriers so they may update your coverage. Please be advised that the entire enrollment process usually takes 2-4 weeks. While your enrollment is
being processed with the insurance carriers, they may report you DO NOT have coverage. This is usually because they have not yet updated your information in their system and
reestablished your eligibility. We do ask for your patience during the enrollment process.
1) You may have to pay for the service out-of-pocket and, once your coverage has been reinstated under COBRA, submit a claim to the insurance carrier for reimbursement
or contact
their member services department to verify whether they can reprocess any denied claims or receive guidance regarding how to submit a claim to them.
Please note: PBS does not process claims. For assistance with claims you need to contact the insurance carrier's member services number for assistance.
2) You may communicate to your provider you are currently electing COBRA, and that during the enrollment process claims may be rejected initially until coverage is reinstated with the applicable insurance carrier(s). If a claim has been rejected, the provider will often have to resubmit it to the insurance carrier once COBRA coverage has been established.
Please note: PBS does not process claims. For assistance with claims you need to contact the insurance carrier's member services number for assistance.
2) You may communicate to your provider you are currently electing COBRA, and that during the enrollment process claims may be rejected initially until coverage is reinstated with the applicable insurance carrier(s). If a claim has been rejected, the provider will often have to resubmit it to the insurance carrier once COBRA coverage has been established.
If you have a baby, adopt a child or get married while on COBRA, you may add a dependent spouse or child to your coverage. You must submit a change form along with a copy of
the birth certificate, adoption , or marriage license within 30 days of the birth, adoption/marriage. Failure to do so will result in forfeiture of the right to add the child or
spouse to your coverage.
If you move, you are responsible for notifying PBS of your new address in a timely manner. This information needs to be provided in writing, so please send change of address via mail,
email or fax. It is also your responsibility to verify with your insurance carrier to make sure your coverage is available in your new area or that you are still
within the network.
Planned Benefit Systems, A WageWorks Company
Attn: COBRA Department
P.O. Box 4594
Greenwood Village, CO 80155-4594
Attn: COBRA Department
P.O. Box 4594
Greenwood Village, CO 80155-4594
Refer to your COBRA Election Notice Information Summary for more detailed information and important deadline dates.
If you have further questions, please contact PBS at: (800) 800-0133 or COBRA@pbs.us.com
If you have further questions, please contact PBS at: (800) 800-0133 or COBRA@pbs.us.com
