Everything you need to know about COBRA coverage

Introduction

Consolidated Omnibus Budget Reconciliation Act (COBRA) benefits refer to the continuation of health insurance coverage provided to Crossover W2 employees after they experience a qualifying event. COBRA allows you the option to extend your coverage under the eligible policies you were enrolled in with Crossover at an unsubsidized rate.

COBRA continuation coverage can become available to you and to other members of your family who are covered under the Plan when you would otherwise lose your group health coverage. The following generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it.

COBRA Continuation Coverage

COBRA continuation coverage is a continuation of group health plan coverage when coverage would otherwise end because of a life event known as a "qualifying event." COBRA applies to each group health plan under the Plan. Specific qualifying events are listed later. COBRA continuation coverage is offered to each person who is a "qualified beneficiary." A qualified beneficiary is someone who will lose coverage under the Plan because of a qualifying event. Depending on the type of qualifying event, employees, spouses of employees, and dependent children of employees may be qualified beneficiaries.

Qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. Federal law does not recognize your domestic partner as your spouse and a domestic partner is not recognized as a COBRA qualified beneficiary.

However, the plan will extend COBRA-like coverage to your domestic partner and his or her covered children other than for losses of coverage due to termination of the domestic partnership. However, COBRA rights and protections do not apply to this extension of domestic partner coverage.

Crossover has delegated authority for administering COBRA continuation coverage to the following COBRA Administrator:

Flores & Associates

P.O. Box 31397

Charlotte, NC 28231-1397

Telephone: 800-532-3327

Facsimile: 800-726-9982

E-Mail: CustomerService@Flores247.com

Upon enrolling in Crossover benefits, Flores sends you a COBRA Initial Notice filled with all the necessary details.

Eligibility and qualifying events

If you are an employee, you will become a qualified beneficiary if you will lose your coverage under a group health plan because either one of the following qualifying events happens:

  • Your hours of employment are reduced resulting in loss of eligibility for benefits; or
  • Your employment ends for any reason other than your gross misconduct

If you are the spouse of an employee, you will become a qualified beneficiary if you will lose your coverage under a group health plan because any of the following qualifying events happens:

  • Your spouse dies;
  • Your spouse's hours of employment are reduced;
  • Your spouse's employment ends for any reason other than his or her gross misconduct;
  • Your spouse becomes entitled to Medicare (Part A, Part B, or both); or
  • You become divorced or legally separated from your spouse.

Your dependent children will become qualified beneficiaries if they will lose coverage under a group health plan because any of the following qualifying events happens:

  • The parent-employee dies;
  • The parent-employee's hours of employment are reduced;
  • The parent-employee's employment ends for any reason other than his or her gross misconduct;
  • The parent-employee becomes entitled to Medicare (Part A, Part B, or both);
  • The parents become divorced or legally separated; or
  • The child stops being eligible for coverage under the plan as a "dependent child."

 

Each group health plan under the Plan will offer COBRA continuation coverage to qualified beneficiaries only after the COBRA administrator (Flores) has been notified that a qualifying event has occurred within 30 days of the date the event occurs.

When the qualifying event is the end of employment or reduction of hours of employment, death of the employee, or entitlement of the employee to Medicare (Part A, Part B, or both), Crossover will notify COBRA administrator (Flores) of the qualifying event within 3 business days of the date the event occurs or the date you would otherwise lose coverage under the group health plan due to a qualifying event, whichever is later.

For the other qualifying events (divorce or legal separation of the employee and spouse or a dependent child's losing eligibility for coverage as a dependent child), you must notify the COBRA administrator (Flores). Each group health plan covered under the Plan requires you to notify the COBRA administrator (Flores) within 60 days after the qualifying event occurs or the date you would otherwise lose coverage under the group health plan due to a qualifying event, whichever is later.

Within 14 days of the COBRA administrator (Flores) receiving notice that a qualifying event has occurred, Flores will send out an election notice, offering COBRA continuation coverage to each of the qualified beneficiaries. Whenever it is Crossover's responsibility to inform Flores about a qualifying event, this will be completed within 3 business days, assuming the job termination or reduction of the employee's hours of employment has been updated in the Crossover portal.

For each qualified beneficiary who elects COBRA continuation coverage, COBRA continuation coverage will begin on the date that coverage under the group health plan would otherwise have been lost. Note that your group health plan coverage through Crossover terminates at the end of the month irrespective of the termination date and the COBRA continuation coverage will automatically start on the first day of the subsequent month. COBRA continuation coverage is a temporary continuation of coverage.

When the qualifying event is the death of the employee, enrollment of the employee in Medicare (Part A, Part B, or both), your divorce or legal separation, or a dependent child losing eligibility as a dependent child, COBRA continuation coverage lasts for up to 36 months.

When the qualifying event is the end of employment or reduction of the employee's hours of employment, COBRA continuation coverage lasts for up to 18 months.

COBRA Qualifying Event Notice

This notice contains important information about your right to continue your healthcare coverage in the plans you have already enrolled through Crossover.

Please read the information contained in the notice very carefully. This notice provides important information concerning your rights and what you have to do to continue your health care coverage under the Plans. The notice also contains the list of qualified beneficiaries, the plans they are enrolled in through Crossover and the new monthly cost for each plan you have to pay. If you have any questions concerning the information in this notice or your rights to coverage, you should contact Flores. The contact details are provided above.

If you don't choose to keep your health care coverage by filling out and sending back the Election Form that came with the notice before the deadline, your coverage will stop at the end of the month when the qualifying event happened because of Loss of Coverage.

If you don't return the completed form to Flores by the given deadline, you'll have to cover your own health care expenses starting the month after the qualifying event happened. In simpler terms, after the month of the qualifying event, if you send the completed form back to Flores and pay them, the insurance company will cover your health care costs according to your plan. 

Your coverage will “technically” continue until the deadline for submitting the election form. The time between the qualifying event month and when you make your first payment is called the waiting period.

To elect continuation coverage you must complete the Election Form and return it to Flores. You can mail it to the address shown on the Election Form. The completed Election Form must be postmarked by <deadline date as mentioned in the notice>. If you do not submit a completed Election Form by this date, you will lose your right to elect continuation coverage.

You can also return the COBRA Election Form included in the notice via fax, or you can upload it to the Flores247 Web Portal at www.flores247.com. To log in, you will use the Participant ID number included in your letter along with the password you created when you set up your account. To set up your log in for the first time or reset your password, please visit: Registration | Flores247.

Important points:

  • Send the election form to Flores for invoices to be generated
  • Insurance coverage is not activated until your first payment is received
  • Coverage will be updated within 10 days
  • Upon receipt of your completed COBRA Election form Flores will bill you on a monthly basis

 

The details of the plans you and qualified beneficiaries have enrolled in with Crossover and the monthly cost that you need to pay for each plan will be there in the COBRA Continuation Coverage Election Form that comes along with the notice.

You can pay online by credit card (Visa or MasterCard) or e-check at www.flores247.com. There is an additional fee applied to pay using Flores website. You can log in to the account using the Participant ID number found on your invoice and the password you created when you set up your account. To set up your account for the first time or reset your password, visit: Registration | Flores247. Flores can also accept automatic Bill Pay sent from your bank.

Even if you do not receive an invoice from Flores, your payment is due the first of each coverage period and failure to make payment within the grace period allowed will result in termination for non-payment. Payment can be made online at www.flores247.com and is subject to convenience fees. Monthly payments can also be mailed using the instructions provided with your first COBRA invoice.

Frequently Asked Questions

Why did I receive a COBRA Qualifying Event Notice?

COBRA Qualifying Event Notices are sent when you experience loss of employer-provided insurance coverage due to certain qualifying events. COBRA allows you the option to extend your coverage under the eligible policies you were enrolled in with the employer at an unsubsidized rate.

When will I receive the COBRA Qualifying Event Notice and to which address it will be sent?

You will get the COBRA Qualifying Notice in the first week of the month following the month when the qualifying event happened. It will be sent to you at the address in your Paychex profile.

Where can I get the details of the plan cost that I need to pay?

The details of the plans you have enrolled in with Crossover and the cost for each plan will be there in the COBRA Continuation Coverage Election Form that comes along with the notice.

Whom to contact if I haven’t received the COBRA Qualifying Event Notice?

You can contact Flores. Flores contact details:

Flores & Associates 

P.O. Box 31397

Charlotte, NC 28231-1397

Telephone: 800-532-3327

Facsimile: 800-726-9982

E-Mail: CustomerService@Flores247.com

When do I have to send the completed election form?

You have to complete the election form and send it to the address before the deadline stated in the COBRA Qualifying Notice. 

How do I elect COBRA coverage?

If you have experienced a loss of coverage due to a Qualifying Event, you will receive a Qualifying Event Notice letter. To elect COBRA coverage, you will return the COBRA Election Form included in the notice via mail, fax, or you can upload it to the Flores247 Web Portal at www.flores247.com. To log in, you will use the Participant ID number included in your letter along with the password you created when you set up your account. To set up your log in for the first time or reset your password, please visit: Registration | Flores247.

When do I have to send in my COBRA payment?

A 45-day window is allowed for the first payment of your COBRA continuation period. After that, payments are due on the first day of the coverage period. For example, for the 5/1-5/31 coverage period the COBRA payment is due on 5/1. You will have 30 days from the due date to make the payment. If payment is not received within the 30 day grace period, coverage must be cancelled by law.

Where do I go to make my COBRA payment online?

You can pay online by credit card (Visa or MasterCard) or e-check at www.flores247.com. There is an additional fee applied to pay using Flores website. You can log in to the account using the Participant ID number found on your invoice and the password you created when you set up your account. To set up your account for the first time or reset your password, visit: Registration | Flores247. Flores can also accept automatic Bill Pay sent from your bank.

When is my COBRA paid through?

You can view your COBRA activity, including your payment status, in the Flores247 Participant Portal. After logging in, select your COBRA account to view activity including your payment history. Enroll in e-Status updates in the Settings tab to receive email notifications when your payments are received and processed.

I made a COBRA payment, but Cigna has not reinstated my coverage. What should I do?

It can take up to 10 business days after you make a payment for COBRA for your coverage to appear as active with Cigna. Coverage will be reinstated retroactively. Providers may resubmit claims for services incurred during the waiting period.

I received a COBRA Qualifying Event Notice. I would like to continue my dental plan, but not my health plan. Is this allowed?

Yes, you may elect to continue each plan separately. If you wish to continue only one plan, select only the plan you wish to continue on your election form. You will only be billed for the plans you select and coverage will only be extended on the plans for which you elect and make timely payments.

Can I continue coverage for just my spouse or dependent?

If your spouse or other dependent was covered on the plan during your active employment, you may drop to an individual policy for them due to individual enrollment rights. You would be billed at the Individual coverage rate on your COBRA Election Form.

I received a COBRA Qualifying Event Notice, but I don’t wish to continue the coverage. Do I need to do anything?

No, however we recommend saving the notice for your records.

How do I cancel my COBRA coverage?

Cancel your coverage by logging into your www.flores247.com account. You may also cancel your coverage due to non-payment of premiums at no penalty.

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