Glossary of Terms

COBRA: The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) is a federal regulation requiring certain employers to allow eligible employees and eligible family members to continue group health care coverage when specific events occur that would normally result in loss of coverage.

OBRA: An 11-month extension, not to exceed a total of 29 months of coverage provided to a qualified beneficiary who is currently on COBRA under an 18-month qualifying event. This extension is granted to qualified beneficiaries who have been deemed disabled by the Social Security administration. The disability date, as determined by the Social Security Administration, must exist either prior to the COBRA qualifying event or at any time during the first 60 days of COBRA coverage. To take advantage of the extension, the qualified beneficiary must inform SHPS in writing of the determination before the expiration of the 18 months of COBRA and within 60 days of receiving it. The extension would be granted to the qualified beneficiaries covered under COBRA, not just to the individual that was deemed disabled. Premiums may increase to 150 percent of the active premium during the OBRA period.

Carrier: Term used to describe the insurance company.

Claim: Service rendered to the participant that is sent to the insurance company for payment.

COBRA FSA: Some employers may offer the continuation of a flexible spending account on COBRA for the current year only.

COBRA Life Insurance: There are no COBRA requirements involving life insurance. Some employers allow continuation of Life Insurance, this is not COBRA

Conversion: A plan that may be offered between the insurance company and the participant once COBRA has ended.

Continuation Coverage Period: The period commencing on the date of a COBRA qualifying event and continuing for the maximum period specific. This is typically an 18-, 29-, or 36-month period.

Continuation Services: The extension of benefits beyond active employment (COBRA, retiree benefits).

Effective Date: The date continuation services begin.

End of Eligibility (EOE): When you have reached the end of the maximum coverage period.

HIPAA: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides expanded rights and protections for participants and beneficiaries in group health plans. Understanding this amendment is important to your decisions about future health coverage. If you find a new job that offers health coverage, or if you are eligible for coverage under a family member's employment-based plan, HIPAA includes protections for coverage under group health plans that:

• Limit exclusions for pre-existing conditions.
• Prohibit discrimination against employees and dependents based on their health status.

HIPAA Certificate: SHPS generally provides a HIPAA certificate to verify continuous coverage through COBRA. This certificate is issued as documentation of your prior health insurance coverage. Give a copy of your HIPAA certificate to your new employer’s health insurance plan administrator to offset any pre-existing condition clauses and to verify you had no lapse in coverage.

Initial Rights Notification: Federal law requires that certain information about COBRA be provided to employees and their spouses at the time the employee is hired. This information is included in an Initial Rights Notification letter.

Lock Box: A secure payment processing center used by SHPS.

Online Payment: The ability to make premium payments using electronic funds transfer (EFT).

Paid through Date: The date your coverage will terminate if you do not make subsequent payments.

PHI: Protected Health Information: Protected health information (PHI) under HIPAA means individually identifiable health information. Identifiable refers not only to data that is explicitly linked to a particular individual (that's identified information). It also includes health information with data items which reasonably could be expected to allow individual identification.

Qualifying Beneficiary (QB): Generally, a qualifying beneficiary is any individual who, on the day before a qualifying event, is covered under a group health plan maintained by the employer of a covered employee by virtue of being: (1) the covered employee, (2) the spouse of the covered employee, or (3) the dependent child of the covered employee. Exceptions include certain nonresident aliens.

Qualifying Event (QE): A qualifying event is any one of the following events that would result in the loss of health insurance coverage: (1) the death of the covered employee, (2) the termination (other than for reasons of gross misconduct) of a covered employee's employment, (3) a reduction in a covered employee's hours of employment, (4) the divorce or legal separation of a covered employee from the employee's spouse, (5) a covered employee becoming entitled to Medicare benefits, (6) a dependent child ceasing to be a dependent child of the covered employee under the terms of the group health plan, and (7) with respect to certain retirees and their dependents, bankruptcy proceedings of an employer under Title 11 of the U.S. Code, commencing on or after July 1, 1986.

Retiree Coverage: The continuation of benefits provided to a retired employee as determined by the employer’s plan guidelines.

Subsidy: Also known as Enhanced Coverage, subsidy is when an employer pays a portion or full amount of the premium for a period of time.

Surviving Spouse: A surviving spouse is an individual who is eligible for continuation services due to his or her spouse’s death.

USERRA: The Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) provides for the continuation of health plan coverage for up to 18 months for those persons on military leave. Because this overlaps with COBRA, there was no functional difference between COBRA and USERRA.

VBIA: The Veterans Benefits Improvement Act of 2004 (VBIA) amended USERRA to extend health plan coverage up to a total of 24 months.