COBRA Plan Overview
COBRA is an acronym for the Consolidated Omnibus Budget Reconciliation Act of 1985.
It allows certain employees and their dependents that would otherwise lose group coverage to temporarily continue coverage with the same plan.
Terms and Conditions of COBRA
- COBRA-eligible members do not have to prove insurability.
- Each COBRA-eligible member can make an independent election on whether to continue benefits.
- COBRA-eligible individuals may continue coverage for 18 months. Certain conditions may allow for continuation up to 24, 29 or 36 months (please view COBRA continuation rights for more details).
Health Plan Options
COBRA participants are eligible for the following two health plans. Click each link for more information:
COBRA Rates
- 80/20 & 70/30 Plans for COBRA
- Medicare Primary Plans for 100% Contributory Medicare Primary Subscribers (COBRA)
COBRA Billing
When members elect and pay to continue coverage, they are enrolled and billed to a current date. Subsequently, COBRA members are billed on a monthly basis, 20 days prior to the period for which premiums are due.
COBRA members can monitor their COBRA participation online at www.mycobra.info . Bank draft is available to COBRA members. More information regarding that option is available at www.mycobra.info.
Notice of Initial COBRA Rights
This explains COBRA continuation rights when health benefit plan coverage would otherwise end because of a life event known as a "qualifying" event.
Medical Policies
Although your Benefits Booklet provides a good overview of what services and products are available to you under the PPO plans, the medical policies provide detailed information around the circumstances under which certain services and products are and are not covered. Medical policies can be found here on the Aetna website*.
* If any of the State Health Plan medical policies conflict with the Aetna medical policies, the State Health Plan medical policies will prevail.
Prior Authorization
Certain services require prior review and certification before they can be covered by your plan. Providers are responsible for submitting the required documentation. Providers can visit the links below for more information.
Appeals
If you disagree with the way a claim has been handled, you can request an appeal or grievance review. For the complete appeals process, please click here.
State Health Plan Policies
State Health Plan Policies and Procedures