Member COBRA Election

Vericred will pass COBRA elections to Carriers

Ideon can handle sending COBRA elections to Carriers that support it. There are a few scenarios when COBRA elections can come up that will require a slightly different integration approach. The scenarios are:

1. Employment Termination & COBRA during Ideon connection: In this scenario, a member was active during a live connection with Ideon, has been terminated from employment, and has opted to elect COBRA.

2. COBRA at start of Ideon connection: A member was on COBRA at the start of the connection with Ideon.

3. Termination of COBRA Coverage: A member is active on COBRA and has opted to terminate their coverage.

Scenario 1: Employment Termination & COBRA During Ideon Connection

To terminate the plan elections made by a subscriber, you will create a Qualifying Life Event of type termination_of_employment. This endpoint will terminate the coverages for the Subscriber and their dependents by adding an end date to each of their coverages.

POST /subscribers/:id/qualifying_life_events

{
    "qualifying_life_event": {
        "event": "termination_of_employment",
        "date": "2021-05-01",
        "eligibility_start_date": "2021-01-01",
        "coverage_period_id": "COVERAGE_PERIOD_UUID",
        "plan_elections": {
            "medical": {
                "plan_id": "PLAN_UUID",
                "type": "election",
                "coverages": [
                    {
                        "member_id": "SUBSCRIBER_UUID",
                        "status": "employer_sponsored",
                        "start_date": "2021-01-01",
                        "end_date": "2021-05-31"
                    },
                    {
                        "member_id": "SPOUSE_UUID",
                        "status": "employer_sponsored",
                        "start_date": "2021-01-01",
                        "end_date": "2020-05-31"
                    }
                ]
            }
        }
    }
}

Once the subscriber is terminated, you can now pass the COBRA election Qualifying Life Event. To do this, the event to pass is cobra, which describes that the member is electing COBRA for the first time for the coverage.

POST /subscribers/:id/qualifying_life_events

{
    "qualifying_life_event": {
        "event": "cobra",
        "date": "2021-05-07",
        "eligibility_start_date": "2021-06-01",
        "coverage_period_id": "COVERAGE_PERIOD_UUID",
        "plan_elections": {
            "medical": {
                "plan_id": "PLAN_UUID",
                "type": "election",
                "coverages": [
                    {
                        "member_id": "SUBSCRIBER_UUID",
                        "status": "cobra",
                        "start_date": "2021-06-01"
                    },
                    {
                        "member_id": "SPOUSE_UUID",
                        "status": "cobra",
                        "start_date": "2021-06-01"
                    }
                ]
            }
        }
    }
}

Scenario 2: COBRA at Start of Ideon Connection

When passing "in-force," or already insured, groups over to Ideon to manage enrollment, a member may have already elected COBRA before being sent to the Ideon Platform. To pass this COBRA election, simply send the event of the latest Qualifying Life Event the member had for their coverage. It that is not known, then it can be passed as initial_enrollment. Another scenario where this same approach is warranted is if this is the first Qualifying Life Event being sent for a member, and that election happens to be for COBRA coverage.

In the example below, the member's last Qualifying Life Event was a marriage event where the Subscriber added their spouse to their COBRA coverage.

POST /subscribers/:id/qualifying_life_events

{
    "qualifying_life_event": {
        "event": "marriage",
        "date": "2021-05-07",
        "eligibility_start_date": "2021-06-01",
        "coverage_period_id": "COVERAGE_PERIOD_UUID",
        "plan_elections": {
            "medical": {
                "plan_id": "PLAN_UUID",
                "type": "election",
                "coverages": [
                    {
                        "member_id": "SUBSCRIBER_UUID",
                        "status": "cobra",
                        "start_date": "2021-06-01"
                    },
                    {
                        "member_id": "SPOUSE_UUID",
                        "status": "cobra",
                        "start_date": "2021-06-01"
                    }
                ]
            }
        }
    }
}

Scenario 3: Termination of COBRA Coverage

When the carrier supports COBRA maintenance through Ideon, COBRA elections and terminations can be sent through the Ideon API. To terminate an existing COBRA election, simply send a Qualifying Life Event with the event corresponding to the reason why they are making the coverage change. This event could be loss_of_coverage if the member is making the action because they lost coverage separately that changed their circumstances, or perhaps divorce because that was the reason they needed to make the coverage change. If there is no reason other than the user simply wanting to terminate their coverage, the event of newly_eligible could be passed.

It is also possible to have an event, like divorce, in which only one member removes coverage. In the example below, there is a divorce and the spouse will no longer have COBRA coverage.

POST /subscribers/:id/qualifying_life_events

{
    "qualifying_life_event": {
        "event": "divorce",
        "date": "2021-07-20",
        "eligibility_start_date": "2021-06-01",
        "coverage_period_id": "COVERAGE_PERIOD_UUID",
        "plan_elections": {
            "medical": {
                "plan_id": "PLAN_UUID",
                "type": "election",
                "coverages": [
                    {
                        "member_id": "SUBSCRIBER_UUID",
                        "status": "cobra",
                        "start_date": "2021-06-01"
                    },
                    {
                        "member_id": "SPOUSE_UUID",
                        "status": "cobra",
                        "start_date": "2021-06-01",
                        "start_date": "2021-07-31"
                    }
                ]
            }
        }
    }
}