4 Replies Latest reply on Jun 15, 2010 9:01 PM by Patgrick

    Health Ins co. will not allow COBRA

    DonaldA
          I am now on medicare and still working. My wife is only 61 and still working. We have considered moving to another state  and not working for a year while we look for a new home to buy . I thought that my wife could keep her insurance unde COBRA for 18 mos. as long as we were willing to pay the premium. Her policy is with Tufts Insurance and is a regional HMO.  She was willing to return to N.E. for occasional office visits if needed and could stay with her sister or brother. She had breast cancer 6 years ago but has been fine since then, but we do not dare have her without coverage.
          On checking with Tufts, they have written into their policy that if a person leaves the area, they lose their coverage, even though they are willing to pay the premiums and return to the area for occasional doctor visits. The local Cobra office said they could do that, though they refused to give me documentation to that effect. The office did send me copy of the law that says an insurance company need not provide some other, national coverage, but we are not asking for that. It does not seem right that a company can disallow a Cobra benefit if the participant is willing to pay the premium. Might any of you have had a similar experience or have any advice?   Thanks.  Don
        • Re: Health Ins co. will not allow COBRA
          katydoes

          I believe all states have a department that oversees insurance companies - possibly located within your state department of health - so you can always run this by them. I wonder what they do if a person takes a vacation out of state and gets sick. This has happened to me and my HMO paid the bill. This raises some interesting questions about COBRA. I got stuck when I transitioned to a new job right when I was turning 65 and using COBRA. SS informed me that COBRA was not considered "equivalent insurance" under Medicare law and that, therefore, I was deemed to have not applied for Medicare in a timely fashion and might be subject to having to pay a surcharge on my Medicare Part B benefits. Go figure!

          Good luck - I'm beginning to realize that this COBRA thing - while in general a wonderful benefit - is more complicated than I thought!

          • Re: Health Ins co. will not allow COBRA
            timelyteri
            This insurance company doesn't want to pay if you don't live there because even though you will come back for visits, if you have an emergency you will have to go to a hospital out of their area. Remember insuranse companies have deals with certain hospitals in their network. With those agreements they usually only pay about 30% of the bill that is charged to the general public. If you use a hospital out of their network in an emergency because you are out of town, they will pay but have to pay at a much higher rate. The same thing goes for all the doctors , surgeons and tests you receive while in the hospital. I work for a hospital and have seen transplant bill of a million dollars and the agreed contrat with the insuranse companies brings it down to $300,000. A big savings for the insuranse companies.
            • Re: Health Ins co. will not allow COBRA
              Patgrick

              Don,

              My HR department told me that under COBRA, as long as I am living in the "coverage area" - the area the company contracted with the insurance company to cover its employees - I am covered.  If I moved to another state, then my coverage would cease.  Leaving for vacation etc., does not terminate my coverage.  Living outside of the area for more than 30 days would terminate my coverage.

              Good luck!