COBRA coverage will go back and cover any bills beginning on April 30, once effective in the system. However, until then, a member may show as having no coverage. They should give providers their ATI card and explain that they are electing COBRA. Request that the provider bill you.
Members should request that pharmacies also bill them but this may not always be possible. If not, the member may have to pay the retail price for the drug out of pocket. If their COBRA kicks in within 10 days of filling the prescription they should be able to go back to the pharmacy and have the claim reprocessed (CVS should do this, unsure about other pharmacies).
After that 10 day window, the member can submit a paper claim form to CVS for reimbursement. CVS will only reimburse them for the negotiated rate for the drug minus their copay. This could be lower than the actual cost paid out of pocket. They can request that the pharmacy reimburse the difference but we think its unlikely the pharmacy would do so.
In extreme circumstances you may submit the bill to the Strike and Defense Fund committee for consideration for payment.
Bottom line - ask all providers to bill you later, explain they are signing up for COBRA. You should save copies of all bills and receipts.
If a member can sign up for spousal coverage but that coverage is not immediately effective April 30 or May 1 – they should elect COBRA!!! They will be eligible for the subsidy for any month they didn’t have other coverage available.
ATI sent out COBRA notices outlining a premium. Members who are eligible for the subsidy (free COBRA) and members who are planning on paying the cost for COBRA should go ahead and sign up- DO NOT IMMEDIATELY SEND ANY PAYMENTS. Around May 17th the Company will send notices telling members about the subsidy and providing paperwork for them to sign up for the subsidy.
Members who have other coverage available but still want to pay for COBRA have 45 days from the date they elect COBRA until they have to make any payment.