UBP blog

07/15/2009

DOL and CMS issue final applications for expedited review of denied ARRA COBRA subsidies

Filed under: ARRA Act COBRA Subsidy,COBRA — ubpblogger @ 10:23 am
Tags: ,

Under the American Recovery and Reinvestment Act (ARRA), COBRA premium Assistance Eligible Individuals (AEIs) who believe that they’ve been wrongfully denied subsidized coverage may apply for an expedited review of their status by one of two federal agencies, the Department of Labor (DOL) and the Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) . Once an AEI applies for expedited review, the DOL or CMS must complete the review within 15 business days.

Individuals who wish to apply for expedited review appeal directly to the federal agencies. Unless either of the agencies contacts them with inquiries for additional information, no further employer action is required.

The DOL and CMS have finalized the application forms that individuals must use and have published them to their websites respectively. Individuals may print a copy of the form and mail or fax it back to the respective federal agency. Individuals using the DOL form may alternatively elect to complete the form online. Which agency’s form the individuals complete is determined by the type of group health coverage they had at their former employer.

Only Assistance Eligible Individuals (AEIs) formerly covered under private-sector group health plans may download and complete the DOL application. Government employees (both federal and state) as well as covered under their state’s “mini-COBRA” law (i.e. companies with fewer than 20 employees for 50% or more of the past calendar year) must use the CMS’ comparable application.

What employers should keep in mind:

When determining COBRA subsidy eligibility for individuals formerly covered under private-sector group health plans, the DOL is not required to defer to your previous decision to deny coverage. The DOL is commonly inclined to rule in favor of an employee’s application.

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