COBRA, Consolidated Omnibus Budget Reconstruction Act, was enacted in 1985 and designed to help employees within the private sector who have recently quit or lost a job or are no longer eligible for private health insurance benefits. Those receiving COBRA benefits must typically pay the premium amount out-of-pocket but can retain their private health insurance for a specified amount of time while in between jobs. COBRA benefits can be revoked for a number of reasons, including late payments on premiums. If you have been terminated yous may write an appeals letter within 30 days of receipt of notice of termination. The letter must include specific reasons or evidence why the termination was wrongful and benefits should be reinstated.
Review the reasons stated in the termination letter as to why the benefits are being suspended. Benefits can be terminated for a number of reasons and you have a right to know why the COBRA benefits will be ceasing. A letter will be provided from the Department of Labor stating the date upon which coverage will cease and the reasons why. Before mounting an appeal, it is vital to understand precisely why the coverage is no longer provided.
Contact an EBSA Employee Benefits adviser at 1-866-444-3272 for help as to why your benefits were cancelled. This person can help you understand whether yourr benefits were revoked during the grace period or after the grace period. Benefits terminated during the grace period are not generally subject to appeal.
Draft a letter stating facts why the COBRA benefits must be reinstated. The letter must provide your full legal name, address, Social Security number and COBRA policy number. The letter should be in proper business format and is best if free from all spelling and grammatical errors. Set forth specific facts relating to why the payments were late and why no future COBRA payments will be missed or paid late. The review committee will be looking for changes in circumstance or additional facts to help make its decision. The appeals letter should be precise, non-emotional and must not invoke accusations or unprofessional language.
Submit the appeal within thirty days of your receipt of the original termination letter. This deadline is very important and late appeals letters will either be dismissed or, at the least, demonstrate to the committee that you have difficulty adhering to deadlines. The letter must be mailed to: U.S. Department of Labor- Employee Benefits Security Administration- Attn: COBRA Appeals, P.O. Box 78038, Washington, DC 20013-9038.
Consider alternatives in the event COBRA benefits are ultimately denied after the appeal. If you are of limited means or have minimal resources, you may be eligible for Medicaid benefits and should apply through the state Medicaid office. In addition, CHIP programs are available to provide health insurance for uninsured children. CHIP is also available on the state level ,and applicants can locate the local office by calling 1-877-KIDS-NOW.