FAQ Item
Question:

What is COBRA?



 

Answer:

COBRA stands for Consolidated Omnibus Budget Reconciliation Act of 1985. It allows you and/or your dependents to keep your health and/or dental coverage under the Texas Employees Group Benefits Program (GBP) for a certain period of time after you leave employment. This is called "COBRA continuation coverage."

COBRA continuation coverage is limited to the medical and dental benefits you have when you leave employment. If you choose COBRA continuation coverage, you will pay the full cost of your premium(s) plus a 2% administrative fee. After you leave employment, ERS will send you a COBRA Notification, election form, rate sheet, and instructions for paying your premiums.

 

FAQ Item
Question:

Can I continue my insurance after my employment ends?



 

Answer:

Yes. COBRA gives employees and/or their dependents the right to temporarily continue health and dental insurance. Insurance under COBRA is available only when insurance ends because of certain life events, such as when your employment ends. 

If you terminate and/or retire before age 65, you may be eligible for up to 18 months of COBRA coverage. In addition, some retirees and their dependents could be eligible for GBP Interim Insurance until age 65. Retirees are encouraged to utilize COBRA coverage first since the premiums for interim insurance are much higher than COBRA. 

 

FAQ Item
Question:

When can I enroll in COBRA?





 

Answer:

Employees ending employment   - Your health and dental coverage ends on the last day of the month in which your employment ends. You may be eligible to continue coverage under COBRA for a maximum of 18 months by paying your premiums directly to ERS. The form and payment must be postmarked no later than 105 days from the date of your employment ending.

Dependents of employees ending employment - Health and dental coverage ends on the last day of the month in which the employee's employment ends. Dependents may be eligible to continue coverage under COBRA for a maximum of 18 months if the dependent lost GBP eligibility. The form and payment must be postmarked no later than 105 days from the date of the employee's employment ending.

 

FAQ Item
Question:

How do I elect Retiree COBRA?



 

Answer:

Upon retiring, you must complete and return a Retiree COBRA Election Form along with the appropriate premium payment to elect continuation of coverage under COBRA. This form, along with a COBRA Notification and a COBRA rate sheet are sent to you at the time your retirement is approved.  The form and payment must be postmarked no later than 105 days from the date of retirement. 

Once a completed Retiree COBRA Election Form and the appropriate premium payment are received by ERS, coverage will be reinstated retroactive to the date of retirement.  You must contact ERS 30 days prior to turning age 65 to have medical coverage as a retiree. ERS does not send an additional notification.  

 

FAQ Item
Question:

How long can I keep COBRA coverage?



 

Answer:

You and/or your dependents can continue insurance for up to 18 months after your employment ended as long as you:

  • do not have other group health or dental insurance, or
  • do not become eligible for Medicare.

An 18-month continuation period may be extended to 36 months if a secondary qualifying event occurs during the initial 18-month continuation coverage period (e.g., divorce, death or loss of dependent status). You are never entitled to more than 36 months of continuation coverage.

 

FAQ Item
Question:

Can I keep or add dependents on my COBRA coverage?



 

Answer:

Any eligible dependent who was covered on medical and/or dental insurance on the day that you ended employment has the right to continue coverage on his or her own. You do not have to continue insurance in order for your spouse or children to continue their insurance.

You can make some changes to your insurance during the Annual Enrollment period and/or you can add eligible dependents that you gain due to a qualifying life event (QLE), such as birth or marriage. You must inform ERS within 31 days of the event so that you can add the eligible dependent that you gained.

 

FAQ Item
Question:

What is the cost for COBRA?



 

Answer:

COBRA Rates for Plan Year 2015 (September 1, 2014 - August 31, 2015)
Rates include 2% administrative fee.

Health Premium Cost

                                                                                                                      
Plan Name - CityYou OnlyYou & SpouseYou & Child(ren)You & Family
HealthSelectSM of Texas$546.15$1,174.22$966.67$1,594.74
Commuunity First Health Plans - San Antonio$478.95$1,029.75$847.74$1,398.54
Scott & White Health Plans - Georgetown, Bryan/College Station, Burnet, Hamilton, Lampasas, Llano, Temple, Waco$550.27$1,183.08$973.98$1,606.79

You will be charged an additional tobacco user fee of up to $90 per month if you do not certify your tobacco user status.

Dental Premium Cost

                                                                                                                    
Plan Name - CityYou OnlyYou & SpouseYou & Child(ren)You & Family
HumanaDental DHMO$10.16$20.33$24.39$34.56
State of TX Dental ChoiceSM$24.05$48.10$57.73$81.78
Dental Discoutn Plan$2.30$4.59$5.51$7.80

When using the chart to determine your monthly premium for continuation coverage under COBRA, note the follow

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  •  If only one child is continuing coverage, then the child is the COBRA applicant. Pay the You (COBRA Applicant) Only rate
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  • If multiple children are continuing coverage, the youngest child is the COBRA applicant. Pay the You & Child(ren) rate
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  • If only the spouse is continuing coverage, the spouse is the COBRA applicant. Pay the You (COBRA Applicant) Only rate
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  • If the spouse and child(ren) are continuing coverage, the spouse is the COBRA applicant. Pay the You & Child(ren) rate.

 

FAQ Item
Question:

Can I continue insurance after COBRA ends?



 

Answer:

You can apply for a conversion policy through your health and dental plan within 30 days after your COBRA insurance ends. We notify you 45 days before your coverage under COBRA ends. At that time, please contact your health and/or dental plan administrator for specific information about a conversion policy.

Disability Extension

If you or any of your dependents are certified as disabled under Title II or XVI of the Social Security Act before or during the first 60 days of COBRA, you may continue insurance for up to an extra 11 months. If you think you or your dependents qualify for this extension, send ERS a copy of your Social Security Administration Notice of Award letter during the first 18 months of coverage. The letter must include the disability onset date.

Secondary Qualifying Events

An 18-month continuation period may be extended to 36 months for your dependents in the event of death, divorce, or the loss of status as a dependent child. 

 

FAQ Item
Question:

Who do I pay for insurance under COBRA?



 

Answer:

Make your check or money order payable to GBP. Please send your first payment with your COBRA election form to ERS. No bills or reminder notices will be sent. 

The initial COBRA premium payment will be due within 105 days of the date coverage terminated or the date of notice whichever is later. Subsequent premium payments are due on the first day of the coverage month.

Your monthly premium payment must be postmarked within thirty (30) days of the due date or coverage will be automatically cancelled retroactive to the last day of the month in which a full premium payment was received and was not considered delinquent. If your coverage is cancelled, ERS will notify you in writing. 

If you receive an annuity from ERS, your monthly premium will be automatically deducted from your monthly annuity payment.

 

FAQ Item
Question:

How long can a disabled individual remain on COBRA?



 

Answer:

If you or any of your dependents are certified as disabled under Title II or XVI of the Social Security Act before or during the first 60 days of COBRA, you may continue insurance for up to an extra 11 months. If you think you or your dependents qualify for this extension, send ERS a copy of your Social Security Administration Notice of Award letter during your first 18 months of coverage. The letter must include the disability onset date.

The premium for disability participants who extend their coverage beyond the initial 18 months of coverage will be calculated at 150% of the current group rate.

 

FAQ Item
Question:

What is Interim Insurance?



 

Answer:

If you have not reached age 65 by the Retiree COBRA medical coverage expiration date and meet service criteria for retiree health coverage, you are eligible for Interim Insurance in the GBP. You pay the total actuarial cost of coverage. Interim Insurance coverage is available until you qualify for insurance at age 65.

Interim insurance is only available through HealthSelect and evidence of insurability is not required. Standard COBRA rules will apply.

 

FAQ Item
Question:

For what reasons can COBRA coverage be cancelled by ERS?

 

Answer:

COBRA coverage may be cancelled prior to the end of the coverage expiration date if:

  • A timely premium payment is not received.
  • The GBP ceases to provide coverage to any employee/retiree.
  • The participant becomes covered under another group health and/or dental plan on or after the COBRA coverage effective date unless the participant is subject to a pre-existing condition limitation or exclusion in the other group health plan. COBRA coverage will end when the new group health plan coverage begins and there is no limitation or exclusion for pre-existing conditions in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  
  • The participant begins receiving Medicare benefits on or after the COBRA coverage effective date.
  • The participant extends coverage due to a disability and later begins receiving Medicare benefits or the Social Security Administration (SSA) makes a final determination that the disability no longer exists.
  • A written request is received from the participant requesting cancellation of coverage. Coverage cancellations will be made effective the last day of the month in which the U.S. Postal Service postmarks the request. A full premium payment must be submitted for the month in which a request for cancellation is submitted.

Once a member requests to cancel, COBRA coverage cannot be reinstated.

 

FAQ Item
Question:

What happens if I become covered by another health plan or begin receiving Medicare Benefits?

 

Answer:

You are responsible for notifying ERS in writing when you enroll in another group health and/or dental plan or begin receiving Medicare benefits. The right to continue COBRA coverage terminates when an individual becomes covered on or after the COBRA effective date by another group health plan that does not limit or exclude coverage for pre-existing conditions OR if you begin receiving Medicare benefits. Your COBRA coverage will be cancelled retroactive to the last day of the month prior to the month in which you first became covered under the other group health and/or dental plan or began receiving Medicare benefits.

Under HIPAA a group health plan's pre-existing condition exclusion period will be reduced month for month by the individual's preceding period of "creditable coverage" under another health plan. The continuous coverage period in another health plan is considered "creditable coverage" provided there has been no lapse in coverage of more than 63 days. COBRA continuation coverage may be terminated if a COBRA participant becomes covered by a new group health plan with a pre-existing condition exclusion clause that is satisfied by the "creditable coverage" provision. The HIPAA rules limiting the applicability of exclusions in most employers' health plans for pre-existing conditions became effective in plan years beginning on or after July 1, 1997.

If a participant becomes covered by another group health plan that limits or excludes coverage for pre-existing conditions on or after the COBRA effective date, COBRA coverage will not be terminated until the expiration of the pre-existing conditions exclusion period. In order to continue COBRA coverage you will be required to provide the following items regarding the other group health plan: documentation of the pre-existing conditions limitation provision, documentation of the effective date of coverage for each person that is covered by the other group health plan and documentation (e.g. medical or prescription billings) indicating that services were provided during the pre-existing period for each person that is covered by the other group health plan. COBRA coverage will be cancelled on the last day of the month in which the pre-existing condition exclusion period expires

 

 

FAQ Item
Question:

What if I return to work for an employer that offers Texas Employees Group Benefits Program insurance?



 

Answer:

Your insurance under COBRA extends to the end of the month when you return to work. You must pay the full COBRA rate for the month you are rehired. Your employer will pay a portion for you and your dependents starting the next month after you rehire date.

If you do not pay the full COBRA rate for the month you are rehire, ERS will cancel your insurance under COBRA. You will be subject to a waiting period with your employer.

 

FAQ Item
Question:

What is FCUC?



 

Answer:

This refers to Former COBRA Unmarried Child. Unmarried dependent over age 26 who is allowed to continue health and/or dental coverage after COBRA continuation coverage expires.

Children age 26 are no longer eligible for the coverage under GBP. Your child is eligible for up to 36 months of COBRA continuation coverage. If your child uses all 36 months of COBRA, and he or she is not married when this time ends, your child may be eligible for health and/or dental coverage indefinitely as a Former COBRA Unmarried Child. 

Coverage as a FCUC ends if the person:

  • marries,
  • becomes eligible for other GBP coverage, for instance as an employee, or
  • stops making premium payments or requests the coverage be cancelled.

One month before your child's COBRA expires, ERS sends an Insurance Enrollment Application for Former COBRA Unmarried Children. To enroll, complete the form and mail it to ERS.