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The American Recovery and Reinvestment Act of 2009, as amended, provides premium assistance for COBRA continuation coverage.
- The Act also says that if a group health plan denies an individual's application for premium assistance, the individual can ask for an expedited review of the Plan's decision.
- The Centers for Medicare & Medicaid Services chose MAXIMUS Federal to provide administrative case management services and answer the public's questions about premium assistance and COBRA continuation coverage.
SPECIAL ANNOUNCEMENT ABOUT COBRA SUBSIDY EXTENSION THROUGH MAY 31, 2010
Additional Extension of Benefit: On April 15, 2010, President Obama signed into law the Continuing Extension Act of 2010, extending the premium assistance subsidy to eligible employees who are involuntarily terminated during the April 1, 2010 through May 31, 2010 period. Previous to that, on March 2, 2010, President Obama also signed into law the Temporary Extension Act of 2010 (TEA 2010). Among its provisions, Section 3 of TEA 2010 extended the premium assistance subsidy to eligible employees who were involuntarily terminated during the March 1 through March 31, 2010 period.
You can access Section 3 of the Continuing Extension of 2010 by clicking on the following link: Text of the Continuing Extension Act of 2010
You can access Section 3 of the Temporary Extension of 2010 by clicking on the following link: Text of the Temporary Extension Act of 2010
Extension of Premium Assistance for Continuation Coverage; Covers Workers Involuntarily Terminated Through February 28, 2010; Lasts for 15 Month Maximum; Applies to Some Workers Retroactively
Extension of Benefit: On December 21, 2009, President Obama signed into law the Department of Defense Appropriations Act, 2010, which extended the premium assistance subsidy in a number of ways. For example, employees who are involuntarily terminated during an additional two months--January and February 2010--may be eligible to apply for premium assistance. And the premium assistance now may last up to 15 months for everyone covered by the extension. For instance, workers and family members who at the time of enactment were still receiving nine months premium assistance may, if otherwise eligible, receive up to six more months premium assistance (for a total of 15 months coverage). Beneficiaries whose nine months of premium assistance expired before the extension was signed into law are afforded the same opportunity to receive up to six months more premium assistance provided they pay their 35 percent due for unpaid premiums within 60 days of such enactment or within 30 days after receiving notice of the extension from their employers or issuers. Those individuals who continued to pay for their continuation coverage after their nine months premium assistance ended and before enactment of the extension may receive credit or a refund for payments above 35 percent of the premium cost.
ARRA, as amended, also changed an eligibility requirement such that the date of the event that qualifies the individual for continuation coverage--rather than the date that the continuation coverage itself starts--determines whether an individual is eligible for premium assistance. (That event, however, must still be an involuntary termination and the qualified beneficiary must still elect continuation coverage.)
The Department of Labor's Employee Benefits Security Administration COBRA page has available model notices updated for the extension provisions of the amendments to ARRA. They are available at http://www.dol.gov/ebsa/COBRAmodelnotice.html.
Text of Section 1010 of the 2010 Department of Defense Appropriations Act (showing the extension of premium assistance for continuation coverage through February 28, 2010).
My request for premium assistance has been denied. What can I do now?
If you believe you are entitled to the premium assistance, you may request that either CMS or the DOL review your case. Each is accepting a separate review form. The DOL handles all cases arising under private sector employers with twenty or more employees, while CMS handles all cases arising under public sector government employers and private sector employers with fewer than 20 employees in states with "mini-COBRA" laws. For more information about the COBRA continuation coverage laws administered by CMS and DOL, visit the About Premium Assistance page on this website.
How do I access and submit the expedited review form?
You must use this form to request an expedited review of a denial of your application for premium assistance.
Closely follow all the instructions on the form and either mail, or fax the form, or have it delivered (by hand or by courier) to MAXIMUS Federal Services at the mailing address or fax number that appears immediately below.
If you experience difficulty faxing us your expedited appeal form, the problem may be due to older fax equipment or technology. If you find you are having a problem, please call us toll free at 1-866-400-6689 to verify whether we have received your fax. You may also wish to consider using a nearby commercial service to send us your fax. This service is offered by many commercial copy and mail service companies
Note: If you need the DOL expedited review form because you or a family member worked for a private sector employer with 20 or more employees, you can access the form by visiting the Department of Labor website (www.dol.gov/ebsa/COBRA/html).
Who is MAXIMUS Federal Services?
MAXIMUS Federal Services is part of MAXIMUS (www.maximus.com), a government contractor with experience in performing impartial reviews of benefit claim disputes.
To ask questions about premium assistance or COBRA continuation coverage, call 1-866-400-6689.
(TTY: 1-866-631-5610) The call is free.
Contact Us:
MAXIMUS Federal Services
COBRA Continuation Coverage - Assistance Appeals Project
800 Cross Keys Office Park
1st Floor - Suite 822
Fairport, NY 14450
Toll Free Fax No. (866) 941-0170
www.ContinuationCoverage.net
You can also send questions by e-mail. A Help Desk representative will respond within one business day.
E-mail address: ContinuationCoverage@maximus.com
Our phone number: (866) 400-6689. Help Desk staff are available between 9 a.m. and 7 p.m. EST