Use this screen to establish and maintain all information regarding an individual's COBRA elections. Such information includes the qualifying event, COBRA status, and benefit elections. This is the core area where you initialize the individual's COBRA information; it serves as the basis for generating coupon books and notification letters.
You must have first initialized qualifying event codes, terminating event codes, health benefit codes and premiums, and the information in the Employee Dependents screen before you enter data into this screen.
Enter, or use Lookup to select, the employee ID for this employee. The employee's name will display to the right of this field. This is a required field.
Enter, or use Lookup to select, the 11-digit employee/dependent's social security number in this required numeric field. Lookup will display the information for the dependents related to the employee ID you have entered, as established in the Employee Dependents screen. The dependent's name and relationship to the employee will be displayed to the right of this numeric field. This is a required field.
After you enter the Dependent SSN, this non-editable field displays the relationship of the dependent to the employee, as entered in the Employee Dependents screen.
Use the fields in this group box to establish the qualifying event, the event date (when you were notified), the due date of the first notification letter as required by law, and a related event if more than one event occurs for an employee/dependent while on COBRA coverage.
Enter the 10-character alphanumeric code, or use Lookup to select the code, that will identify the qualifying event that applies to this record. This is a required field.
Enter the date on which the administrator was notified of the qualifying event. This is a required field. The format for this field is "MM/DD/YYYY."
As required by the Act, an employer must notify employees/dependents in writing about their COBRA options within 14 days of being notified of an event occurring. This field is automatically populated and calculated based on the Event Date entered. You can overwrite this date; however, it is important to remember that this date is the latest possible date you are required to send out a notification letter. If you overwrite the date, the only restriction is that this date cannot be earlier than the Event Date. This is a required date field with the format "MM/DD/YYYY."
If an additional qualifying event takes place while the employee/dependent is on COBRA status and the event is such that it will extend the coverage length, enter the 10-character alphanumeric event code for the related event, or use Lookup to select the appropriate code. Upon entering the related event information, you will be prompted to update the Months of Coverage field and the COBRA End Date if the new coverage length is greater than the original length. The coverage length is determined from the Company Policy Length of Coverage in the Qualifying Events table. This is an optional field.
Use the options in this group box to determine the COBRA status.
Select this radio button if the beneficiary is eligible for COBRA but has not yet accepted or declined. If you select this status, you must enter an Election Pd End Date.
Select this radio button if the employee/dependent has accepted COBRA coverage. If you select this status, you must enter the Accept/Decline Date, as well as the COBRA Start Date and COBRA End Date in the Benefit Elections group box. Additionally, you must enter at least one line in the table.
Select this radio button if the employee/dependent has declined COBRA coverage. If you select this status, you must enter the Accept/Decline Date.
Select this radio button if the employee/dependent has terminated COBRA coverage. If you select this status, you must enter the Terminating Event.
If you selected the Pending radio button and entered a Qualifying Event date, the system will calculate the date in this field by adding 74 days to the Qualifying Event date. This 74 days represents the 14-day lead time for notification plus the 60-day period during which individual can elect or decline COBRA benefits. You can overwrite this date. This is a required field you select when Pending. The date format is "MM/DD/YYYY."
Enter the date COBRA was accepted or declined. This is a required date field if you select the Active or Declined radio button. The format for the date is "MM/DD/YYYY."
Enter, or use Lookup to select, the 10-character alphanumeric code that defines the terminating event for COBRA coverage. This is a required field if you select the Terminated radio button.
Use the fields in this group box to establish the months of coverage for this employee/dependent for this particular qualifying event, and to define the COBRA start and end dates.
This three-digit field will be populated with the months of coverage when you enter the Qualifying Event in the Event Info group box. This field displays the months of coverage based on the company policy length in the Qualifying Events table. This is a required field and can be edited.
Enter the date on which COBRA coverage becomes effective. If you selected the Active radio button in the COBRA Status group box, this date field is required. The date format is "MM/DD/YYYY."
This date field will populate with the ending coverage date for this employee/dependent, based on the Months of Coverage and COBRA Start Date fields. This is a required field, but can be changed. The format for dates is "MM/DD/YYYY."
Enter, or use Lookup to select, the six-character alphanumeric health benefit code for which this record applies. If you selected the Active radio button in the COBRA Status group box, at least one row must be populated in this table.
The description of the related health benefit code is displayed. This description is defaulted in from the Health Benefits table and cannot be changed here.
This numeric field will automatically populate with the premium amount, based on the premium amount for the applicable health benefit code from the Health Benefits table and the Premium Add-on Percent in the COBRA Settings screen. You can edit this field.
Changes to this screen update the following fields:
Track COBRA Elections - H_COBRA_ELEC_EVNT
Employee Dependents - H_COBRA_ELEC_BEN
Cobra Settings - H_COBRA_SETTINGS
Qualifying Event - H_QUAL_EVENT
Health Benefit Event - H_HEALTH_BEN
Basic Employee Info - EMPL
Terminating Event - H_TERM_EVENT
Employee Dependents - H_EMPL_DEPENDENT