COBRA Plan Glossary (I am renewing or adding a COBRA plan, what does this option mean?)

Here you can find helpful information for COBRA rate entry and answers to frequently asked questions regarding COBRA rates.

Written by Taylor Byas

Updated 2 weeks ago

Glossary

Carrier Information

Carrier Name: The specific carrier name (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. If you don't have it at the time of entry, you can enter TBD. This information will be needed post-implementation.

Start Date: The date the plans start, for example, 01/01/2025.

Enrollment Contact: Who Ameriflex should email to notify of CORBA elections and COBRA terminations.

Once a member makes their elections AND initial payment, we will send the carrier reinstatement emails to the carrier contacts the group has on file. From here, the carrier can take on average 5-10 business days to update their system. Please note, the DOL states that it is the employer's responsibility to ensure the carrier systems are adequately updated, so we encourage the employer contacts to also receive these emails. You can only add one contact here; however, if you want multiple contacts to receive these emails, please contact your Client Relationship Team.

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 name or product description provided by the carrier. We will need the exact plan name (not the carrier name).

Note: If you use EDI please ensure this is the same name your EDI vendor has in their system.

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 terminate on the date of the qualifying event. COBRA coverage will start the following day. For example, if the employee is terminated on 04/25/2022, their COBRA will begin on 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 terminated. COBRA coverage will begin on the 1st of the following month. For example, if the employee is terminated on 4/25/2022, their COBRA starts on 05/01/2022.
Employer Notice Rule (also known as WashRoll Rule) - If an employee is terminated between the 1st and 15th of the month, their COBRA will start the following day. If they are terminated between the 16th and 31st of the month, their COBRA will start on the 1st of the following month. For example, if the employee is terminated on 4/12/2022, COBRA will start 4/13/2022, but if the employee is terminated on 4/25/2022, COBRA will start on 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 they had when employed. This is not a decision the Employer or Broker makes - this information will be provided in the plan documents.

COBRA Plan Type: 9 out of 10 times, this will be QB. SPM is a Special Plan Member, usually applied to retirees who 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 choose Fully Insured.

Disability Extension Fee: This is either a 2% or 50% fee that Ameriflex adds to the individual plan rates for anyone 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 with 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

What is the COBRA qualified beneficiary timeline after an employee terminates/loses coverage?

30 days: Broker/Plan Administrator to notify Ameriflex of any new Qualified Beneficiaries via the portal.
14 days: Ameriflex has to mail the Specific Rights Notice.
- Note: Once a COBRA member is entered into the Portal (Federal Regulated System), it takes 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.