COBRA and TEFRA Questions

Unemployment must be fairly high, based on the number of inquiries we have received about TEFRA and COBRA, although TEFRA has nothing to do with unemployment.

Both TEFRA and COBRA are Federal laws.  They are not insurance policies.  TEFRA refers to individuals 65 or over who continue to work full-time for a company with 20 or more employees.  Or, their spouse continues to work full time for a company with 20 or more employees.  It simply means that in this case, the group insurance is primary and Medicare is secondary.  We received a phone call from a doctor’s office, looking for an address so they could bill TEFRA!  You can’t bill TEFRA.  TEFRA is a law; they must bill the insurance company.

We had the same question for COBRA. Where can I bill COBRA?  You can’t.  COBRA is a law that allows you to continue your group insurance for a fixed period of time if you lose your job, become divorced, employee dies or children become of age when they are no longer eligible to be on the Plan.  Once again, COBRA only applies if you work for a company with 20 or more employees.

Someone wanted to call COBRA.  You can’t call COBRA; you must call the insurance carrier.  Some employers handle COBRA benefits themselves while others may hire a company such as COBRASERV or COBRA COMPLIANCE, to name just two, to handle all of their former employees on COBRA.   If you make a check payable to one of these companies, you will want to call them with any problems.  If you make the check payable to the employer and you have a question about enrollment status or eligibility, you will want to call the Employee Benefits Department from your former employer.  If you have a claim problem, you will want to call the insurance company.

A great question that we answered this week was “I have COBRA benefits because of divorce.  I just learned my ex-husband is moving out of the country.  How does this affect my COBRA benefits?  The answer is that it does not affect COBRA benefits at all.  When you go on COBRA, the coverage is in your name, not in the name of the ex-spouse. 

               Irene Card & Betsy Chandler share the responsibilities of running Medical Insurance Claims, Inc. a health insurance services company. If you have questions relative to this column or other related topics, we invite you to call (973) 492-2828, browse our past columns on our web site at  www.micinsurance.com.   

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