FlexToday, Inc.

QUALIFIED BENEFICIARIES:

If you are eligible to continue your group coverage based upon your qualifying event, your dependents (other than domestic partners) who were enrolled in a plan on the day prior to the qualifying event also have an independent right to continue their coverage.  You and your eligible, enrolled dependents shall each be known as a "qualified beneficiary." If you are enrolled in more than one plan, each qualified beneficiary (Employees, Covered Spouse and Covered Dependent(s)) may select which plan he or she would like to continue.  In most cases, qualified beneficiaries may only continue with plans in which they were enrolled on the day prior to the qualifying event. There are two exceptions to this rule. First, a child born to (or placed for adoption with) the employee will be granted all rights of a qualified beneficiary. Second, if coverage is terminated in anticipation of a future qualifying event (i.e. divorce), the spouse and covered dependents shall be eligible for COBRA continuation coverage.

Domestic Partners are not Qualified Beneficiaries and do not have independent COBRA rights.  However, in some situations, the Employer may offer "COBRA-like" continuation coverage for Domestic Partners.  If this is your situation, please ask your Employer if your group health plan allows for "COBRA-like" continuation coverage for Domestic Partners.

COBRA ELECTION DEADLINE

You will have the OPTION to have COBRA coverage but you will NOT HAVE COBRA coverage until you a) formally elect COBRA and b) pay your initial COBRA premiums. If you do not notify our office of your desire to elect COBRA within 60 days of your loss of coverage or 60 days from the date you are notified of your COBRA rights, you (and your covered dependents) will not be able to continue your group health coverage. By law, we are required to respond to inquiries by medical providers regarding your election and payment status.

Until we receive an election form from you or your covered dependents electing continuation coverage, and you pay your initial premium, we will advise such medical providers that you (and your covered dependents) do not currently have coverage but that you may have retroactive coverage if you elect coverage under COBRA and pay your premium. If you need medical services prior to electing COBRA or making premium payments, medical providers may require you to pay for their services in full as a condition of treatment. It may take up to 10 business days after your COBRA election is received and the initial COBRA premiums have been paid before the carriers have their records updated. Some insurance companies require COBRA participants to complete their own preprinted COBRA applications. If you were covered by an insurance plan with that rule, upon receipt of the COBRA Election Form, you will be provided the necessary application(s).

COBRA ENROLLMENT PROCEDURES

You have 60 days from the later of the date of the COBRA Qualifying Event Notice’s date or the date of your coverage termination to accept COBRA continuation coverage.

COBRA TERMINATION

COBRA has maximum time frames for which you may continue coverage under the company's group plan but you may voluntarily terminate coverage at anytime by notifying our office in advance. COBRA provides the plan the right to terminate continuation coverage for any of the following reasons:

1. If the company terminates the plan(s) you are continuing for all active employees. (If a replacement plan is offered, you will be offered the right to enroll);
   
2. If your COBRA premiums are not paid in a timely manner (see COBRA Premiums);
   
3. If you (or covered dependent) become covered under another group health plan after electing to continue coverage, and that plan does not exclude coverage for a pre-existing medical condition affecting you (or covered dependent);
4. If you become entitled to Medicare (Parts A and/or B);
   
5. If you (or a covered dependent) are enrolled in a plan that requires you to live or visit contracted providers in the plan's service area and you move out of that plan's service area, coverage will be terminated. If another plan is available to similarly situated active employees who move out of the service area, coverage under that plan will be offered to you;
   
6. If you have filed fraudulent claims or engage in other activities for which a similarly situated active employee would be terminated "for cause;"
   
7. If you have reached the end of the maximum coverage period under COBRA. You may (or may not) have the right to convert to an individual policy upon completion of your COBRA term; or 8) If a "disabled" participant is deemed by Social Security to be no longer disabled during the eleven month extension. (In this case, the entire family unit will be terminated from COBRA).

OPEN ENROLLMENT

COBRA participants are offered the same rights as similarly situated active employees during open enrollment; they may change plans and add/delete eligible dependents. Although part of the family unit, dependents (other than newborn children and adopted children of the employee) added during open enrollment will not have the same COBRA rights as the initial qualified beneficiaries and, a qualified beneficiary will cease to be a qualified beneficiary if dropped during open enrollment,

MEDICARE & COBRA

How COBRA and Medicare work together is complex and varies depending on numerous situations. There are five unique situations when COBRA and Medicare intersect and may affect your coverage differently. The following rules apply to Medicare and COBRA.

1. Special Medicare Rule - If an active employee becomes entitled to Medicare and later experiences a termination of employment or reduction in work hours, covered dependents are eligible for up to thirty-six months of continuation coverage commencing from the Medicare entitlement date. For example, if an active employee terminates coverage on his 66th birthday, covered dependents would be eligible for 24 months (36 total - 12 covered months) from the date of termination.
   
2. An active employee who is entitled to Medicare prior to experiencing a qualifying event is eligible to elect COBRA. 
   
3. When an active employee becomes entitled to Medicare, dependents losing coverage are eligible for thirty-six months of continuation coverage. (Rarely do the dependents lose coverage because of this qualifying event.) 
   
4. When a qualified beneficiary is enrolled on COBRA and becomes entitled to Medicare, the law states this is a qualifying event. But the IRS has ruled it is not a qualifying event unless the Medicare entitlement would have caused a loss of coverage for the dependents. 
   
5. When a qualified beneficiary is enrolled on COBRA and becomes entitled to Medicare, the qualified beneficiary may be terminated from COBRA.
   

EXTENDING COBRA COVERAGE

After electing to continue coverage under COBRA, there are certain situations that may allow Qualified Beneficiaries to increase the time frame of continuation coverage. If the initial qualifying was termination of employment or a reduction in work hours, qualifying individuals may be eligible to increase their time frame under COBRA. In each of the situations described below, eligible individuals must notify the Plan Administrator (in writing) as explained.

Disability Extension

If your qualifying event is termination of employment or a reduction in work hours and you (or a covered dependent) are determined by Social Security to be "disabled" at the time of the qualifying event (or within the first sixty days of COBRA continuation) through the end of your initial eighteen months, you (and covered dependents) are eligible for the "disability extension." If Social Security determines you (or covered dependent) to be "disabled," COBRA coverage will be extended from eighteen to twenty-nine months. To receive the additional eleven months of coverage, you must provide written documentation from Social Security confirming your disability status during the initial eighteen month time frame and within sixty days of the date that Social Security makes its determination.

The law allows plans to charge up to a fifty percent administration fee during the eleven month disability extension period for a disabled employee and all family members who elect the disability extension. If the disabled employee elects not to continue coverage during the extended period, the remaining family unit may still continue coverage and will be charged the standard administration fee. If you are offered the disability extension and at some point during your eleven month extension Social Security determines that you are no longer "disabled," COBRA continuation coverage will be terminated for the entire family unit. If the qualified beneficiary is determined by SSA to no longer be disabled, you must notify the Plan Administrator within thirty days after SSA's determination.

Multiple Qualifying Event

If your initial qualifying event entitles you and your covered dependents to less than thirty-six months of continuation coverage and during your period of continuation coverage, a covered dependent experiences another (or "multiple") qualifying event, their period of coverage may be extended to thirty-six months. The thirty-six month period is calculated from the employee's original COBRA start date. If a multiple qualifying event occurs, the dependent has sixty days to provide written notification to our office. If this notification is not received within the sixty day time frame, the extension to thirty-six months will be denied. (Note: Employees who experience a reduction in work hours followed by termination of employment shall only be eligible for eighteen months of COBRA continuation coverage.) In no event will COBRA continuation coverage be for longer than thirty-six months. The following shall be considered multiple qualifying events but only if they would have caused the qualified beneficiary to lose coverage had the first qualifying event not occurred: Former employee becomes entitled to Medicare; Death of former employee; Divorce/legal separation; or Covered dependent child who is no longer considered a "dependent" under the plan.

HEALTH INSURANCE PREMIUM PAYMENT (HIPP) PROGRAM

State Medicaid programs have the option of paying COBRA premiums for certain individuals who are eligible for COBRA coverage, if the state determines that resulting savings in Medicaid costs are likely to exceed the cost of the premium. If you are enrolled in or eligible for the Medicaid program in your State (called Medi-Cal in California), you should notify the State Medicaid program that you have been offered COBRA continuation and apply for their HIPP program. IMPORTANT: You are responsible for completing and submitting your COBRA election on a timely basis and you are responsible for paying your COBRA premiums on a timely basis. Failure to enroll in COBRA on a timely basis will result in your loss of eligibility to enroll in COBRA and failure to pay your COBRA premiums on a timely basis will result in your early termination from COBRA.

PREMIUM PAYMENT REQUIREMENTS

You will only receive an invoice and payment coupons to a) confirm your enrollment; b) annually at the beginning of the plan year and c) if the cost of your COBRA premiums change. You will not receive monthly invoices, notices or reminders. You are responsible for making sure that you pay the full COBRA premium that is due by the end of the grace period. If your premium payment is not delivered or postmarked within the grace period, your coverage will be terminated back to the last day for which we received a full premium payment. The US Post Office no longer postmarks mail with computer-generated postage and we do not accept the date of computerized postage as proof of mailing. Unless formally postmarked, payments must be received by the last day of the grace period to be considered timely. FlexToday, Inc. utilizes a process called electronic check conversion to process payments which may cause your payment to be withdrawn from your account faster than a normal check, frequently within 24 hours of its receipt. Courtesy fees apply to credit card payments ($50) and payments made by phone ($20).

Since COBRA is a temporary extension of existing benefits, there cannot be a lapse in coverage. This means that regardless of when you notify us of your decision to accept COBRA continuation, you are responsible for all premiums back to the day you would have lost coverage if you had not elected COBRA continuation coverage.

FIRST/INITIAL COBRA PREMIUM PAYMENT

You must make your first payment for continuation coverage no later than 45 days after the date of your election (this is the date the Election Notice is postmarked). If you don’t make your first payment in full no later than 45 days after the date of your election, you’ll lose all continuation coverage rights under the Plan. You’re responsible for making sure that the amount of your first payment is correct. You may contact FlexToday, Inc. to confirm the correct amount of your first payment. Your coverage will not be reinstated until we receive an election form from you or your covered dependents electing continuation coverage and you pay your initial COBRA premium(s). You are responsible for making sure the amount of your initial premium payment is correct.

COBRA PREMIUM PAYMENTS ARE DUE ON THE FIRST DAY OF THE MONTH FOR THAT MONTH OF COVERAGE AND HAVE A THIRTY (30) DAY GRACE PERIOD:

After you make your first payment for COBRA coverage, you’ll have to make periodic payments for each coverage period that follows on a monthly basis. Under the Plan, each of these periodic payments for continuation coverage is due on the first day of the month for that coverage period. If you make a periodic payment on or before the first day of the coverage period to which it applies, your coverage under the Plan will continue for that coverage period without any break. The Plan will not send periodic notices of payments.

GRACE PERIOD FOR PERIODIC PAYMENTS:

Although periodic payments are due on the dates shown above, you’ll be given a grace period of 30 days after the first day of the coverage period to make each periodic payment. You’ll get continuation coverage for each coverage period as long as payment for that coverage period is made before the end of the grace period. If you don’t make a periodic payment before the end of the grace period for that coverage period, you’ll lose all rights to continuation coverage under the Plan. Your first payment and all periodic payments for continuation coverage should be made payable to FlexToday COBRA and mailed to FlexToday, PO Box 16099, Fresno, CA 93755.

IMPORTANT:  Did you find this page by a web search?    If your COBRA offer letter does not show FlexToday, Inc. in the return address, this is not the right website for you.   Unless we have directly contacted you with information about your Employer's group health plan and your COBRA benefits, please do not use this website and do not send us your medically- or personally-private information and/or banking or credit card information.  THANK YOU!