Keller Rohrback L.L.P. is investigating various health plans, their plan administrators and their service providers, including Paychex, Inc., for violating the notice provisions of the Consolidated Omnibus Budget Reconciliation Act (“COBRA”).
Under COBRA most group health plans are required to provide notice of the right to continuing group health coverage to qualified beneficiaries (typically, the employee, the employee’s spouse (if covered by the plan) and the employee’s dependent children (if covered by the plan)) for 18 months (longer in some instances) when a “qualifying event” occurs.
The following are some of the qualifying events which may cause the employee to lose coverage:
- Termination of the employee’s employment for any reason other than “gross misconduct”
- Reduction in the number of hours of employment
- or Covered employee becomes entitled to Medicare.
When a qualifying event occurs, the plan administrator is required to provide notice of the right to elect COBRA coverage. The notice must be provided to each qualified beneficiary and must, among other things, inform each qualified beneficiary of the amount he must pay for continued coverage. It has come to our attention that COBRA notices do not always comply with these rules. In particular, they sometimes only provide information as to the premium for continued family coverage without also providing the lower premium which each qualified beneficiary would have to pay for individual coverage.