Redwood Health Services
Scope of Included Services
After the Implementation process has been completed, the RHS COBRA Administrator handles ongoing COBRA services. The following is a comprehensive overview of COBRA services
provided by RHS, as well as the Client’s and the Qualified Beneficiary’s responsibilities in the process.
•OnanongoingbasisandonaschedulemutuallyagreedtobyRHSandtheClient,theClientprovidesinformationtoRHSonallemployeesand/orfamilymemberseligibleforCOBRAContinuationCoverage.EmployermustcompleteandsubmitviamailorfaxaQualifiedEventFormprovidedbytheRHSCOBRAAdministratortoRHS,showingqualifiedbeneficiary,qualifyingeventdate,andcurrentbenefitinformation.
•RHSenterstheQualifiedBeneficiaryDataFormintotheRHSCOBRAdatabase.
•RHScreatesandmailstheCOBRAQualifyingEventNoticetotheQualifiedBeneficiarieshomeaddressviaU.S.P.S.certificationofmailingwithin14daysofreceiptoftheQualifiedBeneficiaryDataFormfromtheClient.ThisnoticeinformstheQualifiedBeneficiaryoftheiroptiontoselectCOBRAcoverage,thecostsinvolved,andthelastdayforelectingCOBRAcoverage.Thecertificateofcreditablecoveragewillalsobeincludedinthispacket.
•RHSincludestherequiredMedi-CalNoticeintheQualifyingEventPacketforallQualifiedBeneficiariesresidingintheStateofCalifornia.
•TheQualifiedBeneficiaryhas60daysfromthedatethenoticewasgeneratedorfromthedatethecoveragewaslost,whicheverisgreater,torespondtothisnoticeandelectCOBRAcoverage.ToelectCOBRAcontinuationcoverage,theQualifiedBeneficiarymustreturnasignedelectionformtoRHSpostmarkedwithinthe60-daywindow.
•IfRHSdoesnotreceiveasignedelectionformfromtheQualifiedBeneficiarywithinthe60days,thisconstitutesbydefaultadecisionbytheQualifiedBeneficiarynottoelectCOBRAcoverageandtheoptiontoenrollinCOBRAisnolongeravailable.
•IftheQualifiedBeneficiaryrespondsandelectstheCOBRAcoveragewithinthe60-day
windowofopportunity,theQualifiedBeneficiaryhas45daysfromthedatetheysignedtheelectionformtomakeallpremiumpaymentsnecessarytobringtheiraccountup-to-date.
•Uponreceiptoftheelectionformandpremiumpayment,RHSsendstheQualifiedBeneficiaryasetofpaymentcouponsforthecurrentPlanyearviaU.S.P.S.firstclassmail.ThecouponsindicatetheCOBRApremiumdueeachmonth,wherethepremiummustbesent,andthedateeachpaymentisdue.
COBRA Administration
Redwood Health Services
•Oncetheinitialpremiumpaymenthasbeenreceived,RHSinformstheappropriatecarriersviafacsimilethattheQualifiedBeneficiaryhaselectedCOBRA,paidthepremiumandneedstobereinstatedinthePlan.
•TheQualifiedBeneficiary’spremiumpaymentsareduebythefirstofthemonthforthecurrentmonth’scoverage.EachQualifiedBeneficiaryisgivena30-daygraceperiodinwhichtohavehisorherpaymentpostmarked.AnypaymentsforwardedbeyondthegraceperiodarereturnedtotheQualifiedBeneficiarywithaTerminationNoticeviaU.S.P.S.firstclassmail.AnyQualifiedBeneficiarythatfailstomaketheappropriatepremiumpaymentinatimelymanneristerminatedfromtheCOBRAPlan.
•InsufficientfundsdonotconstitutepaymentandmayresultinterminationoftheQualifiedBeneficiary’sCOBRAcoverage.RHSmailsanInsufficientFundsNoticeviaU.S.P.S.firstclassmailinformingtheQualifiedBeneficiarythattheymaybeterminatediftheyfailtoprovideanewcheckormoneyordertoRHSwithinthestandardgraceperiod.RHSchargestheQualifiedBeneficiaryaNSFfeeforeachcheckthatresultsfrominsufficientfunds.TheNSFfeemustbeincludedintheQualifiedBeneficiary’spaymentortheQualifiedBeneficiaryisterminatedfromtheCOBRAPlan.
•WhenRHSreceivesthemonthlyCOBRApremiumpaymentsfromtheQualifiedBeneficiary,thecheckisprocessedthroughtheRHSFinanceDepartment,andacheckispreparedandmaileddirectlytotheClientfortheQualifiedBeneficiary’sreimbursementofthecarrierCOBRApremium.
•RHSproducesandsendstotheClientamonthlybillingstatementreflectingtheCOBRAAdministrativeServicesforthemonth(i.e.,perPEPMFee,COBRANotificationPacketssent,OpenEnrollmentPacketssent).
•RHSnotifiestheClientofanyCOBRAQualifiedBeneficiary’sterminationofcoverage.
•RHSmailsanEndofEligibilityNoticeapproximately60daysbeforetheQualifiedBeneficiaryreachestheendoftheirCOBRAeligibilityperiodinformingthemthattheymay,ifthecarrierallows,havetheoptiontoconverttoanIndividualPlanthroughtheircarrier.ThisnoticeissenttotheirhomeaddressviaU.S.P.S.firstclassmail.
•QualifiedBeneficiary’swithquestionsand/orissueswillcontacttheRHSCOBRAAdministratordirectlyatthenumberprovidedinthedocuments.QualifiedBeneficiary’swithfamilystatuschangesthatmayaffectCOBRAcoverageshouldcontacttheClientortheRHSCOBRAAdministrator.
•RHSwillmaintainhistoricalfilesoneachCOBRAQualifiedBeneficiaryforaseven-yearperiod.
Reinstatement of COBRA Qualified BeneficiaryThisallowstheClienttoreinstateaCOBRAQualifiedBeneficiarythathaspreviouslybeen
terminated.RHSdoesnotrecommendthatexceptionsbemade;however,weunderstandthattheClientmayfeelitisnecessaryincertainsituations.RHSmustreceivepermissioninwritingfromtheClienttoprocessthereinstatementandconfirmationfromthecarrieraswell.
Enrollment under COBRAOnceaninitialCOBRApremiumpaymenthasbeenreceived,RHSinformstheappropriatecarriers
viafacsimilethattheQualifiedBeneficiaryhaselectedCOBRA,paidthepremiumandneedstobereinstatedintheelectedplan.
2
Redwood Health Services
California Insurance Code Section 10116.5 Administration (Ins. 10116.5)Ins.10116.5allowsCaliforniaStateresidentsoverage60therightundercertaincircumstancesto
continuethemedicalportionoftheirCOBRAcoverageelectionuntiltheyreachage65.Clientscanelect,foradditionalfees,administrationofthiscontinuationofcoveragefortheQualifiedBeneficiary’swhomeetthecriteriasetforthintheGeneralProvisionoftheInsuranceCode.
Open Enrollment ServicesUnderCOBRAlaws,whentheClientholdsOpenEnrollmentforitsactiveemployees,
COBRAQualifiedBeneficiary’smustbeaffordedthesamechoicesthatactiveemployeeshavetheoptiontoexercise.COBRAQualifiedBeneficiary’sarealsoaffectedbyanyratechangesintheClient’sprogram.RHSmustnotifyallCOBRAQualifiedBeneficiary’sby‘SpecialNotification’atleast30dayspriortothesechanges.AllchangesarebasedontheinformationtheClientprovidestoRHS.
HIPAA Certificates of Creditable Coverage:TheCertificateisincludedintheCOBRAserviceslistedaboveatnoadditionalcharge.
Note:TheCertificateofCreditableCoverageisprovidedatthetimeofthe‘qualifyingevent’notificationandatterminationofCOBRAcontinuationofbenefitcoverage.
Below is a list of other COBRA documents provided in the services listed above as necessary and at no (additional charge):EnrollmentConfirmationNoticeIncompleteEnrollmentDeficientPaymentNon-CommencementLatePaymentNoticeTermNotice–ConversionOpenEnrollmentLetterCouponCoverLetterPremiumNoticeCouponsReinstatementPendingTerminationLetterforCADependentNotificationLetterCoverageConfirmationCoverageConfirmation(Spouse)EnrollmentConfirmationAutomaticTerminationNoticeChangeofAddress
PremiumRateChangeEligibilityConfirmationDenialofCoverageCoverageTakeoverUSERRAElectionNoticeMedicarePartDCreditableMedicarePartDNon-CreditableStateContinuationNoticeTerminationConfirmationReinstatement–EnrolledEnrollmentFormReceivedReturnedCheckNoticeMedicareEntitlementNoticeSocialSecurityEligibilityNoticeDisabilityRateNoticeLeaveTerminationNoticeARRANotifications
3
Contact Redwood Health Services
©Redwood Health Services. All rights reserved. 2623 0316
COBRA AdministratorBarbara CannonPhone: 707-525-4292Fax: [email protected]
FinanceRon BurtonPhone: 707-525-4269Fax: [email protected]
Sales and AdministrationJohn Nacol, CPA, CEOLicense: OD88299Phone: 707-525-4370Fax: [email protected]
Director of ClaimsSandy SylversPhone: 707-525-4209Fax: [email protected]
4
Corporate Headquarters3510 Unocal Pl. #108Santa Rosa, CA 95403Toll-free: 800-548-7677Fax: 707-525-4270
Regional Office Orange & San Diego Counties Phone: 949-878-0209
Regional Office Sacramento & Northern Counties Phone: 530-953-8225
Customer ServiceToll-Free: 800-548-7677, option 2Local: 707-544-2010, option 2Fax: [email protected]
