Question about the special enrollment period for health insurance.?

  • by kendall w
  • Jun 13,2018
  • 4 answers

This is about my 1-year old daughter who was on her moms health insurance up until the end of March (at least I believed that). I enrolled her in a private plan under my name (my works health insurance is an extra $125 per week for kids, yikes!) on May 23rd. However, I just found out her coverage terminated on March 14th!
We were initially under the impression that her coverage was through the end of the month, but since they sent the COBRA paperwork by email to the wrong address, she never even got the info until a few weeks ago. And on it it says March 14th for the termination date.. So, we have 18 days to provide proof of a qualifying event. Are we screwed since that is outside of the 60-day window?


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Insurance Answers (4)

Insurance Pickle.com 4 months ago

Pretty much. But, if they e-mailed COBRA info, you'd probably have a good argument to get signed up for COBRA. Because, technically they never notified you.

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Casey Y 4 months ago

That sounds like a pretty rough situation. However, you aren't immune to accountability here. If she lost her job in March and you didn't try to get her onto your policy until May...you would have been outside of the available Special Enrollment period.
If she was intending to purchase COBRA, was it to cover the kid until you were able to add her to your insurance? Or, was the intention to always have a lapse from the end of March through May 23rd?
Ultimately, this is something that should have been addressed in the beginning of April...I think you are out of luck.
Check with state programs for kids. Kids should be covered by a policy and many states have a method to do this. Sounds like you are working, so no subsidy is likely...but you might be able to get her enrolled somewhere...without knowing your state, no way to assist further.
Good Luck. Sounds like a bad situation that got away from you, not that you are a bad person...I hope you can get this resolved.

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StephenWeinstein 4 months ago

You are not as badly screwed as you think.
Here is the loophole:
You can still sign up for COBRA. (For COBRA, you don't have to provide proof, and I think that the time limit is supposed to be measured from when they send the paperwork to the right address, not from when they original sent it to the wrong limit.)
Then enroll her in the private plan during the next regular enrollment period, so that her coverage starts January 1, and cancel the COBRA.

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lucy 4 months ago

The paperwork was sent by e-mail and to the wrong address? If I had to guess the e-mail was her (former) employers e-mail, which she would not have access after being terminated.
In all the years that I had worked, whenever I changed jobs or was laid off would receive the paperwork from Cobra on average of 2 weeks to a month max. And as you found out that the cost of Cobra is (not) the same cost that mom paid through her former employer, but 102%, since now the employer does not contribute their share, since no longer employed.
So it is “possible” that by receiving the 1st notice by wrong e-mail (she kept a copy of it which would show the date on the e-mail), plus receiving the 2nd notice by mail on May 9 which is (almost) 60 days from her termination that it could be disputed that in fact with the dates of notice, you (might) qualify under the 60 day rule? But if they mailed it to a (former) address and she did not inform her employer of the change of address, then that could have delayed receiving the paperwork.
It “appears” that you and the mother do not live together, thus she did not give you this information or could have gotten it and did not inform you in time.
This can be a close call since in “effect” the (new) policy should be effective the 14th or (before), since that would be 60 days.
http://smallbusiness.chron.com/employers...
Qualified Beneficiaries
Employers must giver the former employee's dependents and other qualified beneficiaries an independent opportunity to elect COBRA coverage, even if the former employee chooses not to elect coverage for himself. Qualified beneficiaries are those individuals who were covered under the employee's health insurance as of the last day of work, such as a spouse, parent or child. The plan administrator must notify them in person or by first class mail within 14 days of receipt of notice of the employee's eligibility for COBRA coverage of their independent right to elect coverage. They must be given at least 60 days to make the election.

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