DOL alert: New appeals form for COBRA denials

May 29, 2009 by Kerry Isberg

Posted in: COBRA, Employment law, Health care, In this week's e-newsletter, Latest News & Views, Money, Terminations

Along with all the new wrinkles in COBRA, here comes another: a special Department of Labor form for ex-employees who want to appeal their denial of COBRA subsidy benefits — putting more pressure on employers to make sure denials are valid.

The DOL just posted on its Web site the form – “Application for Review of Denial of COBRA Premium Reduction.” (To see the form, go to www.dol.gov/ebsa/COBRA/main.html). The appeal form, available both to former employees and their eligible family members, can be completed online or filled out on paper and mailed or faxed to the agency.

DOL is telling applicants to include anything they think would help review the application, such as the COBRA election notice, insurance card, paystubs showing deductions for health benefits, and any documents detailing the date/circumstances of the termination and denial of premium reduction. The online version makes appeals easy — and probably more common — by walking applicants through the process screen by screen.

Check your denials
The availability of this form makes it critical that you reject for a COBRA subsidy only those terminated employees you’re certain don’t qualify — otherwise, you may hear from DOL. Remember, the subsidy only applies to those meeting these requirements:

be eligible for continuation coverage under COBRA or a state law that provides comparable continuation coverage (for example, so-called “mini-COBRA” laws) at any time during the period beginning 9/1/08 and ending 12/31/09
elect continuation coverage (when first offered or during the additional election period), and
have a qualifying event for the continuation coverage that is the employee’s involuntary termination during the period beginning 91//08 and ending 12/31/09.

Tags: Application for Review of Denial of Cobra Premium Reduction, COBRA, department of labor, dol

One Response to “DOL alert: New appeals form for COBRA denials”

Richard Meek Says:
June 9th, 2009 at 10:30 am
Dear Sir or Madam:

I received a letter about COBRA benefits from an insurance company that my employer deals with. It states in the very first line:

“On 3/22/2009, you experienced an event of a/an Termination which constitutes a qualifying event under the [name of company I worked for] group health plan(s).”

It goes on to say that I can elect COBRA coverage.

I don’t like the term “Termination.” I worked for an employment agency that placed me on an assignment at a company. I worked there for 1 1/2 years and received a positive performance review by my agency after 1 year. My assignment ended because of lack of work with my last day being 2/23/2009, not 3/22/2009.

I contacted my agency every week for work but told there was none. I filed for unemployment and was granted it by Ohio Dept of Job and Family Services due to lack of work.

My agency filed an appeal which was originally denied by ODJFS then redirected to an appeals commission. I just received notice from ODJFS that my agency has dropped the appeal.

My concern is that if I elect COBRA then I am admitting I was terminated on 3/22/2009 and thus will lose my unemployment benefits from that date forward. I continue to call in for work and the people there say they put me down that I called in for work. I tried to arrange for a short-term landscaping project with someone who called my agency’s office to verify my employment. My agency never returned the call. Thus, I did not get the job.

I have not received any word or documentation that I was fired for gross misconduct. I did not quit.

I would think I would receive COBRA for “reduced hours.” Of course, it is zero. Does “laid off” come under a “termination event?”

I need to decided whether or not to file for COBRA by Wednesday, June 10, 2009. I know this is short notice but any assistance with this is greatly appreciated.

Sincerely,

Richard Meek