COBRA Rate Glossary & FAQ

Here you can find helpful information for COBRA rate entry, and answers to frequently asked questions in regards to COBRA rates.
Written by Taylor Byas
Updated 4 weeks ago

GLOSSARY

Carrier Information

Carrier Name: The specific carrier name is an important piece of information needed (i.e. BCBS TX, BCBS NJ, Aetna, UHC, etc.).

Policy Number: The policy number is the group number assigned by the carrier to your organization. For Humana only plans, this will be a group of information containing the group ID, product code, package/benefit ID, and division or category ID separated by spaces that correspond with that product description/plan name. If you don't have it at the time of entry, you can enter TBD. This information will be needed post-implementation. 

Start Date: Date this new plan starts/renews.

Enrollment Contact: It is the Plan Administrator’s responsibility to terminate the employee off of active benefits immediately. Ameriflex will then reach out via email to the carrier enrollment contact for such things as reinstatement if the participant elects COBRA, or sending a termination notice when the COBRA participant stops paying. If the Plan Administration or Broker wants to be listed here, please know they are in charge of contacting the carrier when they receive any carrier notices for those instances and any others. 

Note: If a team inbox is used, and not a specific person’s email, you can split the team name between the First and Last name boxes. As always provide the email address

Plan Information

Plan Name: The plan name is the name or product description provided by the carrier. We will need the exact plan name (not the carrier name).

Insurance Type: This is specific for each plan you are creating. For example, if you are providing information for your medical plan, you will select medical from the dropdown.

Plan Rate Type (one of the following): 

  • Composite: Rates that are based on Employee, Employee + Spouse, Employee + Child, etc.
  • Age Banded: Rates based on age ranges of employees
  • Flat Rate: All members would pay the same amount for coverage
  • Member-Specific: Rates that depend on the participants and their coverage type (this is a rare occasion for Qualified Beneficiaries but more common for Special Plan Members)

Plan Available to a specific division: Does the group have multiple locations? If not, then the answer is no. If yes, then do the rates differ per location? (This is considered location-specific rather than member-specific)

This plan can be bundled: A bundle is when two or more plans have to be elected together.  (Example: Employees must choose plan x & y, and cannot just elect x)

Benefit Termination Type (one of the following):

  • Date of Qualifying Event: Employees' coverage with the group will term the date of qualifying event. COBRA coverage will start the following day. For example, employee termed 04/25/2022, COBRA will start 4/26/2022.
  • End of Month/Extended Employer Notice Rule - Employees will have coverage with the group until the end of the month they are termed in. COBRA coverage will begin the 1st of the following month. For example, employee termed 4/25/2022, Cobra starts 05/01/2022.
  • Employer Notice Rule (also known as WashRoll Rule) - If an employee is termed between the 1st-15th their COBRA will start the following day. If they are termed through the 16th-31st their COBRA will start the 1st of the following month. For example, employee termed 4/12/2022, COBRA will start 4/13/2022, employee termed 4/25/2022, COBRA will start 5/1/2022.

Plan available for conversion: This is the ability, in some states, to switch a job-based health coverage plan to an individual policy when the participant loses eligibility for job-based coverage. This means any eligible participant can continue coverage, not under the group, but on their own with the same rates that they had when employed. This is not a decision that the Employer or Broker makes - this information will be provided in the plan documents.

COBRA Plan Type: 9 out of 10 times, this is going to be QB. SPM is a Special Plan Member, usually applied to retirees that have specific rates. Ameriflex is just a billing service for these groups.

Insured Type (one of the following):

  • Fully Insured: This is when the insurance company reviews and pays all claims. (This is the most frequent answer)
  • Self-Insured: Do you act as your own insurance company, meaning you review and pay all claims? If yes, select this option. If not, you will select Fully Insured.

Disability Extension Fee: This is either a 2% or 50% fee that Ameriflex adds to the individual plan rates for anyone who would be on disability. The 50% option is the total disability fee that includes the 2% from Ameriflex, and this option would be more for a company that has a high rate of disability employees because it helps offset any large claims. So Ameriflex would either charge 102% or 150% of the premium to that individual who is on disability. This is not related to a disability plan, it is for someone who is already on disability and elects COBRA as well.

Note: If left blank, Ameriflex will default to a 50% disability fee.  

ADDITIONAL COBRA NOTES

Timeline:

  • 30 days: Broker/Plan Administrator to notify Ameriflex of any new Qualified Beneficiaries via the COBRA portal.
  • 14 days: Ameriflex has to mail Specific Rights Notice
    • Note: Once a COBRA member is entered into COBRAPoint (Federal Regulated System), that takes that 14 days down to 1 day because a notice will automatically be generated overnight and mailed out the next business day.
  • 60 days: Members have 60 days to elect COBRA.
  • 45 days: Members have 45 days from the date they elect to make their first full premium payment.
  • Members' premium payment is due on the 1st of each month and they have a 30-day grace period to pay. 

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