COBRA Administrative Services

The Vendor is required to provide administer all aspects of COBRA continuation in accordance with Federal COBRA regulations on behalf of the County.
- Initial Notification
•    Initial notification to each newly eligible employee, spouse, and dependents and to each newly enrolled spouse in accordance with federal cobra regulations.
•    Official notice must be mailed to the last known home address via first class mail, with proof of mailing in accordance with federal cobra regulations.
•    Initial notification copies must be archived for at least six (6) plan years.
- Qualifying Event Notices
•    Qualifying event notices must contain all the statutory language and terms of the model notice as defined in the federal cobra regulations.
•    Qualifying event notices must be sent to qualified beneficiaries via first class mail within 14 days of notification by the county and must be managed by the vendor in accordance with federal cobra regulations and posted simultaneously to each qualified beneficiary’s online or digital account.
•    Event notification and proof of mailing must be documented to defend against failure disputes and archived for at least six (6) plan years from the date qualification for cobra continuation ends for each qualified beneficiary.
•    The administrator must follow up on non-deliverable notices and archive proof of follow-up for six (6) plan years.
- Customer Service for Qualified Beneficiaries
•    Must provide a toll-free phone number for country based live customer service at least 10 hours a day between the hours of 7:00 a.m. And 7:00 p.m. ET on business days.
•    An online portal and other digital tools are expected to be available to each qualified beneficiary as an option for electronic elections, payments, and information.
•    Must provide qualified beneficiaries access to accurate election, payment, and participation information 24 hours a day/365 days a year via online or digital means.
•    Minimal wait time for phone call response and issue resolution is expected.
•    Must process and manage cobra continuation for all qualified beneficiaries and all plan types in accordance with federal cobra regulations.
- Election Process
•    The election process and all aspects of cobra continuation must be administered in accordance with federal cobra regulations.
•    Ineligible elections must be automatically rejected by the system and prompt notification sent to the applicable qualified beneficiary (IES).
•    The administrator must ensure that the applicable insurance plan carriers are notified of accurate coverage elections as quickly as possible once elections and premium payments have been validated.
•    Documentation of each election and associated continuation details must be archived for at least six (6) plan years.
- Qualified Beneficiary Billing and Collecting Premiums
•    Cobra billing statements must be mailed monthly or monthly coupons provided upon election, with clearly stated amounts, including due dates, grace periods, cancellation details, etc. In accordance with federal cobra regulations.
•    Premium payments will not be accepted unless accurate and received timely. 
•    Payments received with a postmark beyond the grace period may not be accepted.
•    Qualified beneficiaries must be notified promptly if a partial payment is received within the grace period and must be permitted to cure the shortfall within the grace period. 
•    Cobra may not continue if a partial payment is not cured to full payment.
•    Grace period notices must be mailed and documented according to federal cobra regulations.
•    Copies of actual checks, check envelopes, and electronic payment records must be archived for at least six (6) plan years.
- Appeals Administration
•    The administrator must manage cobra-related appeals by qualified beneficiaries, in compliance with regulatory standards, including eligibility disputes, termination of continuation coverage or rights, and premium payment issues.
•    The administrator will work with the county for the approval of appeal decisions.
- Data Sharing for Affordable Care Act Reporting
•    The administrator will provide timely and accurate healthcare plan participant and enrollment data to the county’s third-party affordable care act (aca) compliance vendor in a format that will allow them to accurately populate the IRS 1095-c forms for cobra participants and irs annual reporting at no additional cost.
•    This includes that the administrator will support secure data exchange formats that are compatible with the aca vendor’s system.
- Regulatory Compliance Updates
•    The administrator must implement and execute all federal and/or state cobra regulatory changes, including but not limited to notice revisions, eligibility updates, and system modifications, at no additional charge to the county or its participants.
•    Any regulatory updates must be integrated into existing services without requiring separate contracts or amendments.
- Client Accounting
•    The county will receive a single payment each month, along with a detailed statement that itemizes each cobra premium received.
•    The county must be notified immediately of elections and terminations of benefits.
•    Any regular updates will be provided to the county indicating who should be added to or deleted from the plan.
- Client Reporting
•    The administrator must provide reports to be viewable or provided to the county upon request.
•    Reports must be customizable to include categories including administrator performance indicators, employee utilization data, and selection data.

- Contract Period/Term: 3 years