What is
COBRA?

COBRA is an acronym that stands for the Consolidated Omnibus Budget Reconciliation Act of 1985. This federal law allows employees the right to continue participating in their group health insurance coverage after leaving their job. COBRA gives participants, who would otherwise lose coverage as a result of certain events, the opportunity to temporarily continue their group health care coverage under their employer’s plan on a self pay basis.

HOW DOES PROGRESSIVE BENEFIT SOLUTIONS HELP?

Progressive Benefit Solutions, LLC is the billing entity for qualified beneficiaries who enroll through COBRA while the insurance carrier still oversees the coverage aspect of benefits. We are the advocate to ensure appropriate notifications are provided, process elections, bill and record premium payments to ensure paid in full. We notify COBRA participants of plan and rate changes when health plans renew as well as notifying insurance carriers of the enrollment changes. We are here to help you through the process of all the necessary COBRA/HIPAA administration.

ALL ABOUT COBRA

1   Employer sends eligibility file to PBS

2   PBS sends COBRA Specific Rights Notice and election information to qualified beneficiaries (QBs)

3   QBs elect coverage and make payments for each month they’d like to continue coverage

4   PBS communicates eligibility and coverage changes to insurance carriers

COBRA

COBRA is not a health insurance plan. The Consolidated Omnibus Budget Reconciliation Act protects you and your family if you lose your employer-sponsored health benefits.

You are eligible for COBRA coverage if you were participating in your employer-sponsored COBRA eligible health plan that before the Qualifying Event occurred.

COBRA coverage may be offered to employees, an employee’s spouse, or an employee’s dependents. In certain cases, this includes a retired employee, and the retired employee’s spouse and dependents. If you are expecting a child or adopt a child during the period in which you are receiving coverage through COBRA, then that child will also qualify as a dependent.

The below chart outlines the circumstances under which you or a covered dependent may opt to continue your health insurance coverage through COBRA:

Qualifying Events for COBRA
Employee
  • If you leave your job voluntarily; this includes retirement
  • If your work hours are reduced so that you are no longer eligible for health benefits under your employer’s policy
  • If you leave your job involuntarily for any reason other than gross misconduct
Employee’s Spouse
  • If the employee’s work hours are reduced
  • If the employee leaves the job for any reason other than gross misconduct
  • If the employee becomes entitled to Medicare
  • Divorce or legal separation
  • Death of the employee
Dependent Children
  • If the employee’s work hours are reduced
  • If the employee leaves the job for any reason other than gross misconduct
  • If the child loses dependent child status under the employer sponsored health plan’s rules
  • If the employee becomes entitled to Medicare
  • Divorce or legal separation
  • Death of the employee

Medical, Dental, Vision, Flexible Spending Account (FSA), & Health Reimbursement Account (HRA)

You have 60 days to elect your COBRA coverage and an additional 45 days after you elect your benefits to make payment.

Please allow 5-7 business days for enrollment to become effective.

You may setup automatic monthly ACH withdrawal transactions from your bank account or pay online by credit or debit. A $20 convenience fee is applied to one-time payments online but does not apply when setting up monthly ACH withdrawal transactions directly from your bank account.

The Registration ID is needed to become an authorized user in the COBRA portal. You can find your Registration ID in the New Member Login letter.

Please visit https://cobrapoint.benaissance.com/

Click on COBRA LOGIN then NEW USER link and follow the registration process as described. Please note you will be asked to supply a second piece of identification which will be your social security number (SSN). In order to expedite the registration process, please make sure you have this information with you before beginning the new user registration process.

Please contact PBS if you need any further assistance at (203) 208-4800

No, payments can be made online at https://cobrapoint.benaissance.com/ or by mailing a check to PBS (14 Business Park Drive #8, Branford, CT 06405)

Refer to your New Member Login letter to pay online or login to your account.

Partial payments can be made during the month, but the partial payments must equal the total premium due at the end of the month.

Yes, you may pay in advance for more than one month at a time by mailing in a check.

You will only receive a new insurance card if your healthcare plan changes during Open Enrollment.

If you have an appointment before your insurance is active, you will need to pay any expenses out of pocket. After the insurance is activated you can have the provider reprocess the claim for that service date.

Please contact PBS to notify us of your effective end date.

Please refer to your State’s Health Insurance Exchange if you choose to not elect COBRA through your prior employer

A health insurance exchange is an online marketplace where consumers can compare and buy individual health insurance plans.

https://www.healthinsurance.org/glossary/health-insurance-exchange/

HSA

A Health Savings Account

Per IRS regulations, you may only contribute to the FSA if it becomes LMT (Limited FSA) meaning it covers dental and vision expenses only.

Contributions for an HSA are not front loaded, they build up from the participant’s payroll contributions.

On your consumer portal you will have the option to create a distribution, for reimbursement.

  • $3,550 for an individual
  • $7100 for a family.
  • HSA owners over age 55 have the chance to add an extra $1,000 to their HSA’s each year above the annual contribution maximum

Yes, you must have the above plan to qualify to open and contribute to a HSA account.

No, HSA funds do not have an expiration date.

You can contact any bank who offers the HSA; that bank becomes the custodian of your account

HSA eligible expenses are all 213 expenses. Please visit www.pbscard.com and refer to the PBS list under form downloads for FSA eligible/ineligible expenses.

Please also feel free to visit https://hsastore.com/

  • All items in a purple add to cart are eligible to purchase without additional documentation

You can obtain a medical necessity form (also under form downloads) signed by a doctor (MD) with a description of why the expense is necessary to improve or mitigate an existing condition.

Yes, the employer can make pre-taxed contributions to your account.