How does COBRA insurance affect your workers’ comp benefits in Georgia?
If you are receiving workers’ compensation benefits and you are terminated (fired) from work, or the authorized treating doctor puts you on temporary or permanent total disability, you should continue receiving workers’ compensation checks, even if your salary checks stop.
But what happens if your employer fires you when you still have a pending workers’ compensation case?
If you are out of work permanently—before your case is decided—your workers’ comp insurance benefits will end the same way. This is where COBRA sometimes comes into play.
Under COBRA, you may continue receiving coverage, at least for a limited period of time, under your own policy.
Here is what you need to know about COBRA and its interaction with Georgia workers’ compensation.
What is COBRA?
COBRA, which stands for Consolidated Omnibus Budget Reconciliation Act, provides health coverage to families that lose group health coverage when an employee is terminated from work, is divorced or they change jobs.
COBRA requires group health plans to continue offering coverage temporarily when an employee faces an event that disqualifies them from benefiting from workers’ compensation. Under the Act, the employee, their spouses, former spouses and their dependents should continue receiving coverage temporarily when group health coverage may be lost due to some life events.
Such events include:
- Death of the employee
- Termination from work
- Reduction in the number of hours worked
- Legal separation or divorce from the covered employee
- Covered employee benefiting from Medicare
- A child losing the dependent status
An employee who elects to continue coverage after any of the events above will need to pay the full cost of the group coverage and give the employer a 2 percent administrative fee. The amount you pay for coverage will be more than you would have as an active employee.
Usually, the employer pays a part of the coverage amount, and you only pay a small percentage. When you are terminated from work, you pay the full amount of the coverage.
Who benefits from COBRA?
COBRA applies to group health plans offered by private-sector employers (with 20 or more employees) and by state and local governments in Georgia. If you are covered by a plan sponsored by the federal government, church or an organization affiliated with a church, you may not qualify for benefits under COBRA.
Under COBRA, group health plans are put in place by an employer to provide an employee and their families with medical care through either insurance or health maintenance organizations. Such an arrangement helps cover:
- Physician care
- Prescription drugs
- Dental and vision care
- Surgery and other major medical benefits
- Inpatient and outpatient hospital care
It’s important to understand that COBRA will NOT apply to plans that provide disability-only benefits and life insurance.
To benefit from COBRA, you must meet the 3 basic requirements below:
- Your group health plan is covered by COBRA.
- A qualifying event occurred.
- You are a qualified beneficiary.
COBRA and workers’ compensation
If it so happens that your employer can’t accommodate your work restrictions, and they put you out of work (or your authorized medical care provider writes you out of work), you will continue receiving your workers’ compensation health insurance checks even if your regular checks stop.
This is referred to as temporary total disability (TTD). When this happens, consider speaking with a workers’ compensation attorney near you about the interaction between workers’ compensation and your health insurance coverage.
If you have always contributed to your health insurance through your paycheck, then you should check with your employer without assuming that your insurance contribution is coming from your workers’ compensation TTD check. If your employer continues paying the premiums for you, but you don’t pay your part of the insurance premiums, then your health insurance coverage might be canceled without your knowledge.
If you lose your employment after filing for Georgia workers’ compensation, your health insurance benefits will end the same way. In this case, your health plan administrator likely needs to send you a notification prompting you to choose to continue benefits under your group coverage plan.
You will typically have 60 days to accept or lose all your benefits. If your employer was paying a percentage of your health insurance plan, expect to pay more money to keep the insurance plan active.
Once the coverage starts, the employee will need to meet their obligations to keep it active. Coverage can stop any time due to:
- Failure to pay your premiums on time
- The employer terminating the group health plan
- Qualified beneficiaries choosing another group health coverage plan after electing COBRA
- The beneficiary becoming qualified for Medicare benefits
- The beneficiary engaging in fraud or other misconduct
You should get an early termination notice if the continuation coverage is to be terminated.
When to consult a Georgia workers’ compensation attorney
If your health condition persists or worsens and you can’t return to work for a long time, the employer may ask for your return-to-work status from your workers’ comp insurance carrier. The group health insurance may also inquire about your return-to-work status after receiving a huge insurance claim. This is where the employer realizes you should have taken COBRA continuation coverage, which they may have failed to notify you about.
If you aren’t sure how your work status affects workers’ compensation and group health insurance, seek legal help. An experienced workers’ compensation attorney gives you an edge when negotiating with big insurance companies looking to avoid paying coverage.
