1.

Who is entitled to benefits under COBRA?

Q. Who is covered under COBRA?
A. COBRA is available to former employees of firms with 20+ employees. Qualified beneficiaries include employee's and their dependents. COBRA is extended following a qualifying event

2.

Who are COBRA beneficiaries?

Q.Who qualifies as a COBRA beneficiary?
A. Former employees, their spouse, natural born and legally adopted children who were covered the day before a qualifying event. In some cases a beneficiary may also be a retired spouse or the retired employee/spouses dependent children...

3.

What is a COBRA qualifying event?

Q. How is a qualifying event defined?
A. Qualifying events cause beneficiaries to lose their group health coverage. Such events can include voluntary or involuntary termination of employment for other than cause...

4.

What is a qualifying event for a spouse?

Q. Does a spouse have a different definition of a qualifying event?
A. In addition to the qualifying events for employees, a spouse may also experience a qualifying event in the case of divorce or death of the covered employee...

5.

What is the Newborns' and Mothers' Health Protection Act of 1996 (Newborns' Act)?

Q. How does the NMHPA affect pregnant women?
A. The Newborns' Act affects the amount of time you and your newborn child are covered for a hospital stay following childbirth. Group health plans, insurance companies and health maintenance organizations (HMOs) that are subject to the Newborns' Act may not restrict benefits for a hospital stay in connection with childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section.

6.

What is the Women's Health and Cancer Rights Act (WHCRA)?

Q. I have breast cancer. What rights do I have under the WHCRA?
A. Insurance carriers and HMO's that offer mastetcomy treatment must also cover reconstructive surgery to restore the breast. In addition to covering costmetic reconstruction, surgery to allow the breast to support a prosthesis is covered.

7.

What is a copay?

Q. Is a copay the same as coinsurance?
A. Copays are fixed amounts the insured must pay at the time medical services are rendered. Typical copay amounts are $30, $40, $50, etc.

8.

What is coinsurance?

Q. When is coinsurance applied?
A. Coinsurance usually follows satisfaction of the major medical deductible. Coinsurance means the carrier pays a percent of the eligible charges and you (the insured) pay the balance...

9.

Can I get a better rate by going direct to the carrier?

Q. Is it cheaper to go direct?
A. Some folks will have you believe that you can get a better rate by going direct to a carrier or buying online from a website. The fact is, all carriers charge the same rate for the same plans whether you go direct, use an online agency or a local agent...

10.

So what did I really buy when I got this plan?

Q. So what did I really buy when I got this plan?
A. When I ask clients what kind of coverage they have now, most don't have a clue. They might know how much the doctor copay is, and if they take medication, they may know their share of the cost...