Provide written notification that you want to terminate your coverage. If you fail to pay your premium within the 30-day grace period, your coverage will be retroactively terminated for failure to pay premiums.
What if I become eligible for Medicare while on COBRA?
The insurance carriers will terminate your coverage under COBRA due to your Medicare entitlement the first day of your birthday month even if you wanted to keep COBRA coverage.
What are the benefits of COBRA coverage over Individual coverage or Exchange coverage?
If you have already met your deductible or out-of-pocket maximum on the group plan before being eligible for COBRA, it might be advantageous to stay on the COBRA plan until the end of the calendar year. If you move to an individual plan or Exchange plan mid-year, your deductible will reset to zero when that individual policy or Exchange policy begins. While all plans are different, it is common for COBRA coverage to have greater benefits due to being a group plan. Individual and Exchange coverage can be more expensive for older individuals because rates are based on age.
Are there alternative benefits I may be eligible for in addition to COBRA coverage?
Yes. Having one of these events will qualify you to apply for Individual insurance and/or the State or Federal Exchange. It is important to consider the benefits of COBRA, individual coverage or exchange coverage and the costs. If you elect COBRA coverage, you will not have an opportunity to apply for individual coverage or Exchange coverage until the next open enrollment period (typically January 1st).
What is the grace period to pay my COBRA premiums once I’m enrolled?
The monthly premium is due the first of every month with a 30-day grace period. Payment must be postmarked no later than the 30th day of the month in which the COBRA premium is due. If NOT postmarked by the 30th day in which it is due, your coverage will be terminated back to the first of the month you failed to pay the premium on time.
Do you accept credit card payments?
No. We have in the past but the bank fees we must pass along to COBRA participants are too cost prohibitive. We do offer Electronic Funds Transfer from your bank account. Please note there is a $2.50 fee to use this service.
How will I pay my monthly COBRA premiums?
You will be mailed payment coupons until the next benefit renewal month. The coupons will list the benefits you’ve elected, how much they cost, and where to mail your payment. You may use these coupons to mail a check every month or if you use your bank’s bill-pay service, no coupon is needed. Alternatively, you can pay via Electronic Funds Transfer using this link. Please note there is a $3.00 fee to use this service.
What happens after I elect COBRA?
If you’ve paid the premium, your healthcare coverages will be reinstated back to the loss of coverage date. Your medical ID card will begin working again (in most cases) and you will not be mailed a new one (in most cases). Any medical deductible you may have met earlier in the plan year will be credited to your COBRA coverage.
My COBRA Election Notice included several healthcare benefits; do I have to elect all of them?
No. You can pick the benefit(s) you want. You may also drop dependents at this time but you cannot add dependents unless it is open enrollment for that particular benefit.
Do I have to mail the COBRA Election Form with payment?
No, however you will not be enrolled in benefits without payment. If you elect COBRA by mailing the COBRA Election Form without payment, you will have an additional 45 days to make all retroactive premium payments from the postmark date of the COBRA Election Form.
How long do I have to respond to the COBRA Election Notice?
You have 60 days from the loss of coverage date or the date the COBRA Election Notice was mailed (whichever is the later) to respond by mailing your COBRA Election Form.
How long must I wait to receive a COBRA Election Notice?
It must be mailed within 44 days from your “COBRA Qualifying Event” date.
What if I am already enrolled in Medicare Part A or both Part A & B when I have a COBRA qualifying event?
You are eligible for 18 or 36 months of COBRA coverage depending on your “COBRA qualifying event.” Becoming eligible for COBRA has great impact on your Medicare coverage. It would be wise to consult with an insurance broker with specialized Medicare training in order to review the facts and circumstances of your situation. Enrolling in COBRA coverage could have unintended Medicare consequences.
What type of event will entitle me to COBRA eligibility and for how long?
- Termination of Employment – an employee has terminated employment. The employee and covered dependents are entitled to 18 months of COBRA eligibility.
- Reduction of Hours – an employee has reduced hours to the point where they no longer qualify for benefits under the group healthcare plans. The employee and covered dependents are entitled to 18 months of COBRA eligibility.
- Divorce –a COBRA Election Notice will be mailed to the ex-spouse based on the court-appointed date of the dissolution of marriage entitling him/her to 36 months of COBRA eligibility.
- Legal Separation – Based on the court-appointed date of the legal separation. A COBRA Election Notice will be mailed to the legally separated spouse entitling him/her to 36 months of COBRA eligibility.
- Loss of Dependent Status – a covered dependent child turns age 26 and will lose coverage at the end of their birthday month. A COBRA Election Notice is mailed to the 26 year old entitling him/her to 36 months of COBRA eligibility.
- Death of Employee – an employee has died. A COBRA Election Notice will be mailed to the surviving dependents that were covered on the employer’s group benefits entitling them to 36 months of COBRA coverage.
How do I change my POP election if I have an eligible change in status?
If you need to make a change of election for any eligible reason, you must complete a Change of Status form. This form needs to be completed within 30 days of your event to increase, decrease or stop your payroll contributions on a pre-tax basis.
What if I have a financial hardship, can I stop participating in a POP then?
Unfortunately, no. Financial hardship is not an acceptable/eligible change of status reason. If enrolled in the Premium Only Plan, you may not change your salary reduction election by terminating insurance coverage for you, or your covered dependents, mid-plan year if you are responsible for a portion of the insurance premium.
Can I decide to stop participating in a POP mid-year?
During the plan year, you may not change your election unless you have a “Change in Status.” Currently, Federal Law considers the following events to be eligible changes in status.
- Marriage, divorce, legal separation or annulment, death of a spouse
- Change in the number of dependents including birth, adoption, placement for adoption, or death of a dependent
- Any of the following events for you, your spouse or dependent: termination or commencement of employment, a strike or lockout, commencement or return from an unpaid leave of absence, a change in worksite, or any other change in employment status that affects eligibility for benefits
- A change in residence for you, your spouse, or dependent that affected eligibility for benefits
- One of your dependents satisfies or ceases to satisfy the requirements for coverage due to attainment of age, student status, or any similar circumstance
- A cost or coverage change in benefits that affected eligibility for you, your spouse or dependent
- A prospective election change to terminate group coverage for you, your spouse or dependent(s) during the open enrollment period offered by the State Marketplace for individual medical coverage
- If you work for a large employer and you are a variable-hour employee, you may experience a reduction of hours and loss of benefit status due to the Affordable Care Act’s Look Back Measurement period calculation. This is an eligible change of status reason to end your participation in the Premium Only Plan. Check with your employer to find out if you are in this exact circumstance.
What happens to my HRA if I leave the company mid-year?
For a terminated employee or any Participant who is no longer eligible under the terms of this Plan, claims will still be reimbursed but only if such reimbursement requests are made by the earlier of (1) 60 days following the date that you ceased employment or eligibility; or (2) the end of the 60-day period following the close of the Plan Year in which the expense arose. Termination of employment concurrently terminates your eligibility and participation in the plan. Any claims submitted after that time will not be considered.
How do I find out what I have paid toward my deductible or coinsurance for HRA purposes?
Since each insurance carrier has a different Explanation of Benefits form and lists the deductible expenses and coinsurance expenses in different places on the form, we’ve provided samples of EOBs from some of the major medical providers in Washington, Oregon and Alaska for your convenience. Click on a sample EOB below (based on your medical insurance carrier):
Where do I submit my HRA claim?
Fax (866) 320-1932
Mail: 18887 State Highway 305, Suite #600
Poulsbo, WA 98370
Email: [email protected]
When will I be reimbursed for my HRA claim?
All faxed/mailed claims received between Monday and Friday are adjudicated as they are received, with reimbursements generated the following week.
How do I claim reimbursement for a coinsurance HRA?
You must submit a completed HRA Medical Coinsurance Claim Form and provide a copy of each “Explanation of Benefits” (EOB) sheet from the insurance company showing medical charges applied to coinsurance.
How do I claim reimbursement for a medical deductible HRA?
You receive reimbursement by submitting a completed HRA Medical Deductible Claim Form and provide a copy of an “Explanation of Benefits” (EOB) or “Benefit Summary” from the insurance company showing you have met your out-of-pocket employee deductible responsibility.
Can I take both the dependent care tax credit on my tax return AND use the FSA account to pay for my dependent care expenses?
No. Whether or not to participate in the daycare portion of this plan depends on your income, filing status, number of dependents and annual daycare expenses. Contact Sound Benefit Administration at (360) 779-7047 to assist you in determining whether participation in this plan or taking the dependent care credit on your tax return will give you greater tax savings. You cannot do both because it is considered “double-dipping.”
Can I submit FSA daycare expenses for reimbursement if my spouse is not employed?
If a spouse does not work, and is not disabled or a full-time student, daycare expenses are not reimbursable. If your spouse is either a full-time student or not able to care for himself or herself, your spouse will be considered to have earned income of $250 a month if there is one qualifying dependent in the home, or $500 a month if there are two or more qualifying dependents in the home. Therefore, qualified daycare expenses are reimbursable.
What paperwork do I need to submit an FSA daycare claim?
We have two daycare claim forms for you to use. The first is when you use a licensed provider who supplies monthly invoices for daycare services. The monthly invoice should include the contact information and the Federal Tax ID number of that provider. The second form is for non-licensed providers who do not provide a monthly invoice. Complete this form and request the signature of the daycare provider. No additional receipt is necessary when you use this form. Remember, it is not necessary that you pay your daycare provider before you submit a daycare claim. Both claim forms are available in the forms library.
If the cost of the orthodontia treatment is higher than my employer’s annual maximum election limit or my annual election, can I request for the remaining balance to be reimbursed in the next FSA plan year?
Only if the orthodontia treatment continues into the next plan year. If the treatment is completed during the current year, no balances can be carried over to the next plan year.
Do I have to pay the orthodontia charge in full before it can be reimbursed to me through the FSA?
No. It is not necessary to pay the entire amount up-front in order to be reimbursed for the total contracted amount. Remember, we can only reimburse you for the total cost up to your annual election, less previous reimbursements. Read more here.
Can the cost for orthodontia treatment that lasts longer than the current plan year be reimbursed by the FSA up-front?
Yes. Submit a claim form requesting your out-of-pocket expenses along with a copy of the orthodontia contract and we will reimburse the total amount of the treatment up-front up to your annual election, less previous reimbursements. You will no longer have to submit a Claim Form each month as services are rendered for reimbursement.
What do I need to do if I terminate employment and I’m an FSA participant?
You have 60 days after your last day at work to submit claims incurred during the plan year up to your last day worked. After 60 days your run-out period has ended unless you work for a COBRA eligible employer and have elected the FSA as a COBRA benefit. NOTE: The 2.5 month extension or $500 carry-over balance does not apply if you terminated employment.