Retiree/Dependent Eligiblity

yakley · January 2004

I've got the proposed new notices to use.
An employee will be retiring 2/1/04. Has family coverage for himself and spouse. Spouse has been determined to be totally disabled by SSA and qualified for Medicare January 1, 2004.

Our policy allows retirees and dependents to remain in our group for medical and dental coverages until certain criteria is met, and we contribute to the premiums.

Upon retirement by the employee, does the spouse become a qualified beneficiary eligible for benefits for 29 months? Even though she's eligible for Medicare now?

Retiree says to change family coverage to individual upon retirement.

Tks.

irenesmsaclaims · January 2004

If the retirement does not cause a loss of coverage since you allow retirees to stay on, then there would be no COBRA qualifying event. Are there other factors not in your post?

yakley · January 2004

It's the dependent that I'm stuck on.
She's eligible for Medicare and can't continue to be a part of the group. Is she eligible for
the 29 months continuation?

Tks.

irenesmsaclaims · January 2004

Under the COBRA rules, no. She doesn't fit into any of the qualifying events. The QE about Medicare entitlement has to do with the employee.

Pearce · January 2004

If the spouse is losing coverage because she does not meet the plan's definition for eligibility as a dependent of the retiring employee, then she is losing coverage because of the employee's retirement or termination of employment. The spouse would then be a qualified beneficiary and eligible for COBRA continuation. If the spouse is disabled (by the SSA) at the time of the employee's termination of employment and loss of coverge, or within the 60 days after that date, the spouse would be a QB eligible for the 11 month extension (29 months of COBRA coverage).

irenesmsaclaims · January 2004

I'm not sure I'm following. The employee isn't losing coverage due to retirement because retirees can stay on the plan. The wife (I don't know their definition of dependent) has no qualifying event (divorce, separation, dependent child reaching the limiting age). She is entitled to Medicare, which isn't a QE for dependents under COBRA, even if their plan disqualifies a dependent for being Medicare-entitled.

Pearce · January 2004

I guess the real answer can only come once someone clearly understands what the original poster means. It is not clear whether the spouse of the retiring employee will lose eligibility for coverage by definition in the plan when the employee retires.

My answer assumed that because of the spouse's age or some other eligibility rule in the plan, the spouse would lose her ability to have coverage under the plan as a dependent of the retiring employee. If that is the case then the retirement, which is a termination of employment, would be a loss of coverage due to termination of employment and I believe that loss of coverage would make the spouse a Qualified Beneficiary and thus eligible for COBRA coverage.

Retiree/Dependent Eligiblity

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