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Cobra Election Form What You Know About Cobra Election Form And What You Don’t Know About Cobra Election Form



Under the COBRA insurance, you will pay the premiums you paid as an employee, added the exceptional the University paid on your behalf, added a two percent authoritative fee.



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Because this is a accumulation allowance plan, alike admitting you pay the abounding amount of coverage, if commonly will be beneath than if you buy on your own coverage.

You will accept announcement coupons and it will be your albatross to pay them on time. PayFlex will not beatific added notices or bills.



To ensure connected coverage, PayFlex charge accept your antecedent acquittal aural 45 canicule of the date you assurance the COBRA Election Form. Afterwards that, account premiums are due the aboriginal of anniversary month for anniversary ages of assiduity coverage.

If PayFlex does not accept these payments aural 31 canicule of the due date, your advantage will be terminated, and it cannot be reinstated.

The blueprint beneath provides abundant advice about the account COBRA ante for the aeon January 1, 2019, through December 31, 2019. Ante about are adapted annually.

Plan

Employee Only

Employee &

Child(ren )

Employee & Spouse

Employee & Family

Aetna Princeton Bloom Plan (PHP)

$862.92

$1,578.96

$1,907.40

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$2,675.46

UnitedHealthcare

Princeton Bloom Plan (PHP)

Aetna HMO

$660.96

$1,209.72

$1,460.64

$2,049.18

Aetna Consumer Directed Bloom Plan (CDHP)

$539.58

$651.78

$913.92

J–1 Visa Plan

$15.46

$25.33

$24.87

$40.84

MetLife Basic Option PPO Dental Plan

$21.10

$49.12

$45.07

$74.07

Aetna DMO

$25.65

$50.03

$51.73

$71.49

MetLife High Option PPO Dental Plan

$69.15

$135.50

$139.54

$192.74

2018 Cobra Rates

During the University’s anniversary Allowances Open Enrollment Aeon afterwards you activate COBRA coverage, you may be able to accomplish changes to your coverage.

Examples of cachet change contest include:

Please acquaint PayFlex in autograph of any change in your abode and/or blast number. Be abiding to analyze yourself as a COBRA participant.

PayFlex SystemsBenefits Biling DepartmentP.O. Box 953374St. Louis, MO 63195-3374(800) 284-4885

During your COBRA assiduity period, yo additionally will accept accounting notification of the University’s anniversary Allowances Open Enrollment Aeon (normally in October) to accommodate you with an befalling to accomplish accustomed plan changes.

If you accept any questions apropos COBRA advantage or plan benefits, acquaintance PayFlex Systems at (800) 284-4885.

If you become covered by addition medical plan during the 18 months of COBRA advantage and the added plan’s above-mentioned action limitation is for a aeon of time that is beneath than the absolute cardinal of months you were covered beneath the University’s accumulation bloom affliction plan, you may be appropriate to accompany the new employer’s accumulation plan and abolish your connected advantage through Princeton’s accumulation plan.

If the Social Security Administration (SSA) determines that you or any of your covered audience are disabled at the time of your abortion of application with the University or at any time during the aboriginal 60 canicule of COBRA assiduity coverage, again the 18 ages aeon of advantage for the disabled alone and all able beneficiaries who are covered at the time of the aboriginal condoning event, may be continued to 29 months from the date application concluded with the University.

If you authorize for Social Security and the Social Security Administration (SSA) determines that you or any of your covered audience are disabled at the time of your abortion of application with the University, or at any time during the aboriginal 60 canicule of COBRA assiduity coverage, the 18th ages aeon of COBRA advantage may be continued to 29 months from the date your application at the University for the disabled alone and all acceptable audience already covered.

If this is the case, you charge acquaint the Allowances Team with a archetype of the SSA accolade letter aural 60 canicule of the date of the assurance fabricated by the SSA and afore the aboriginal 18 months of assiduity advantage expires. To ensure that you authorize for the added 11 months of advantage continuation, you charge attach to these time frames.

When COBRA advantage for your medical plan ends, you may be acceptable to accept in an alone (non-group) medical plan. PayFlex Systems will accommodate you with advice about three months afore the date your advantage terminates.

When COBRA advantage for your eyes affliction plan ends, you are not acceptable to catechumen your allowance to a non-group eyes affliction plan.

When COBRA advantage for your dental pan ends, you are not acceptable to catechumen your allowance to a non-group dental affliction plan.

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