Post Employment Medical Coverage

Welcome to the School District of Philadelphia's Continuation of Coverage page

DISCOVERY BENEFITS

Handles the enrollment and payment processing for COBRA and Retiree subscribers.  If you are already enrolled in coverage, click here for forms and contact information for Discovery.

The contact number for Discovery Benefits is toll Free: (866) 451-3399 option 1, 2

**In order to expedite your call, when prompted, enter the last 4 digits of your social security number and your ZIP Code.  This will move your call to the priority call line.**

Important Information:

PA Acts 110/43  Two acts of the Pennsylvania State Legislature go beyond COBRA to provide additional coverage opportunities for eligible retired school employees.  Commonly referred to as PA Acts 110/43.  Act 110 (1988) requires school employers in Pennsylvania to give retirees and their spouses the right to continue coverage in the group health plan to which they belonged as employees.  The coverage may continue until they are eligible for Medicare benefits (usually age 65) or until they are covered by another group health insurance plan.  Act 43 (1989) amended Act 110 by defining those retirees eligible for continuation of group coverage as those who meet one of the following criteria:

  • took superannuation retirement on or after age 65 (age 62 if PSERS class T-C or T-D)
  • retired with thirty (30) years of service
  • are receiving PSERS disability benefits

Most, but not all, retirees find it advantageous to continue in their former employer plans until they become eligible for Medicare.  Your eligibility for this coverage ends when you begin to receive Medicare benefits.

Return to Retiree Coverage:  If you do not elect District retiree health coverage upon retirement or later drop District coverage to be covered under another employer group plan, you may later enroll in the District retiree coverage, if you experience a Qualifying Event and provide documentation of continuous group coverage since retirement.

You must contact the Employee Benefits office, benefits@philasd.org,  within 30 days of loss of coverage to request enrollment materials.

A Qualifying Event is your involuntary loss of health care coverage under a non-public school employer’s health plan (including COBRA continuation coverage)
A change in your family status (including divorce, death of a spouse, addition of a dependent through birth, adoption, or marriage, or loss of a dependent through loss of eligibility)

Qualifying Events apply to your spouse as well as to you. Dated proof of continuous coverage and qualifying life event documentation will be required.

Disability Generally, the maximum period of COBRA continuation coverage is 18 months.

If you are granted a Public School Employees’ Retirement System (PSERS) Disability Retirement, you are entitled to continuation under PA Acts 110/43.  NOTE that if you become eligible for Medicare based on a Social Security Disability, you must contact the Benefits office as your eligibility for the SDP coverage ends.  You have the option to enroll in Medicare plans through the Health Options Program(HOP) Medicare plan.  Contact the Employee Benefits office at (215) 400-4630 for more information.

If you do not have a PSERS Disability, but you or a family member becomes disabled at any time either before becoming eligible for COBRA continuation coverage or within the first 60 days of being covered by COBRA continuation coverage, you may be able to extend the maximum period of COBRA continuation coverage of 18 months, by up to an additional 11 months. This could result in a total of 29 months of COBRA continuation coverage. This disability extension will apply to the all family members who are receiving COBRA continuation coverage due to the same qualifying event as the person disabled.

In order to qualify for the disability extension to COBRA continuation coverage, the Social Security Administration must find you or an enrolled family member were disabled at some point prior to, or during the first 60 days of COBRA continuation coverage. Therefore, if you believe you may qualify for the disability extension, it is important to contact the SSA and apply for disability benefits under the Social Security ACT. In addition, you must notify the Discovery Benefits of the SSA determination of your disability before you are entitled to the disability extension.

Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986. 

Please See the sections below for more information on how this program works:

General Information

COBRA is an acronym for Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986.

COBRA provides certain former employees, retirees, spouses, former spouses, and dependent children the right to temporary continuation of health coverage at group rates. This coverage, however, is only available when coverage is lost due to certain specific events. Group health coverage for COBRA participants is usually more expensive than health coverage for active employees, since usually the employer pays a part of the premium for active employees while COBRA participants generally pay the entire premium themselves. It is ordinarily less expensive, though, than individual health coverage.

Several events that can cause workers and their family members to lose group health coverage may result in the right to COBRA coverage. These include:

Voluntary or involuntary termination of the covered employee’s employment for reasons other than gross misconduct.
Reduced hours of work for the covered employee.
Divorce or legal separation of a covered employee.
Death of a covered employee.
Loss of status as a dependent child under plan rules.

Alternatives to COBRA

You will need to do some research and comparison shopping.  Make sure that you do not have a lapse in coverage.  You may want to enroll in COBRA while you research other options.  Here are some tips and suggestions:

Do you have coverage available through a spouse or other employer? You may have coverage available through your spouse’s employment or a second job.  Typically if you notify them of your loss of coverage within 30 days, you may enroll in their plan at that time.  Check with the employer’s Human Resources or Benefits department.   If they require proof of loss of coverage, contact Independence Blue Cross at 1-800-ASK-BLUE to request a HIPAA Certification of Coverage.

Are you or a spouse age 65 or over, or eligible for Medicare due to a disability? Contact Social Security at (800) 772-1213 or www.socialsecurity.gov about enrolling in Medicare Part B. If they require a Request for Employment Information form, contact the Employee Benefits Office (215) 400-4630 to have this completed. If you are Medicare eligible and begin collecting your pension, you may enroll in Medicare plans through PSERS Health Options Program (800) 773-7725. Information on individual Medicare plans is available at https://www.medicare.gov/.

Are your children under age 19? If you live in Pennsylvania, CHIP covers all uninsured kids and teens up to age 19 that are not eligible for Medical Assistance. When your child loses health benefits because of your job loss, the six month waiting period is waived.   For more information see the PA Covers Kids or in New Jersey contact NJ Family Care.

Do you or someone in your family qualify for Medicaid?  In general, you must meet specific medical eligibility requirements, and/or age and be financially needy.  You can find out if you qualify for and apply for Pennsylvania Health and Human services benefits on their website site, COMPASS.  You can apply at any time during the day or night from home, a library or any location with Internet access.  Or you visit your local County Assistance Office.

Are there non-group plans available?  You may want to contact an insurance broker or call insurance companies directly to find out what plans are available.  If you meet the underwriting requirements, rates will typically be much lower than COBRA for younger subscribers.

What if I am not in excellent health?  If you do not have a break in coverage, you may be able to enroll in a HIPAA Continued Coverage plan or conversion plans directly through Independence Blue Cross.  Contact them at 1-800-ASK-BLUE (1-800-275-2583) for information.

Does everyone in my family need to elect the same coverage?  Everyone who elects COBRA must elect the same plan.  However, you may find that a combination of some family members electing COBRA and others getting individual plans may provide the best coverage for your needs.  When requesting quotes for coverage, get rates based on each individual as well as for your whole family.

Who’s eligible for this benefit?

When you are hired, you receive an initial notice for you and your covered dependents, informing you and your eligible dependents (i.e., spouse, domestic partner, and children) of your rights under COBRA and describing provisions of the law.

To be eligible for COBRA coverage, the qualified beneficiary must have been enrolled in our group health plan while you worked for the District.

How and when can I enroll for these programs?

COBRA continuation coverage is available upon the occurrence of a qualifying event that would, except for the COBRA continuation coverage, cause an individual to lose his or her health care coverage.

The District notifies our Third Party Administrator, Discovery Benefits, of a qualifying event within 30 days.  You must notify the Benefits department of a qualifying event within 60 days after divorce or legal separation or a child’s ceasing to be covered as a dependent under plan rules.

Discovery Benefits will mail you an election notice not later than 14 days after we notify them that a qualifying event has occurred. You then has 60 days to decide whether to elect COBRA continuation coverage. You have 45 days after electing coverage to pay the initial premium.  Coverage is not accessible until enrollment is completed and Payment have been made. You are responsible for ensuring delivery and confirming receipt.

The notice will list the last date your Health Benefits Continuation Plan Enrollment Form can be received by Discovery Benefits.  The Welcome Package indicates the amount due and the date it must be received by Discovery Benefits.  If do not send payment with your Enrollment Form, coverage will not be active until payment is received.

Your coupons will run through the end of the following JUNE or the end of your eligibility, whichever is earlier.  Payments are due on the first day of each month and must be postmarked no later than the last day of the month for which they are due. Failure to pay premiums by the due date will result in the cancellation of your participation in the Health Benefits Continuation Plan. There are no exceptions for COBRA subscribers.

Contact information for Discovery Benefits is:

Continuant Services

CobraAdmin@discoverybenefits.com

Toll Free: (866) 451-3399 option 1, 2

Hours of Operations:

Monday – Friday

7:00 AM to 10:00 PM EST

 

When and how can I make changes or unenroll?

The School District of Philadelphia permits COBRA subscribers to add eligible dependents to their coverage during our annual open enrollment in May, effective July, or within 30 days of a qualifying event.  Open Enrollment notices are mailed to subscribers in late April.  This is your opportunity to add or remove an eligible dependent or switch between plans without a qualifying event.  Completed forms and documentation must be submitted to Discovery Benefits as directed in the notice.

You may drop COBRA coverage at the end of any month. You may also drop part of your coverage (i.e., dental, prescription and Vision) or remove dependents at the end of any month. Contact Discovery Benefits in writing of any change requests.  Be sure to notify Discovery Benefits of changes so coverage is not terminated for non payment.

Note, you may not add coverage or dependents except at Open Enrollment or in case of a family status change.

What does it cost and how do I make payments?

When you were an active employee, The District paid a large part of your group health premiums. Under COBRA, as a former employee, you will pay the entire premium amount plus a 2 percent administrative fee.

While COBRA rates may seem high, you will be paying group premium rates, which are usually lower than individual rates.

Since it is likely that there will be a lapse of a month or more between the date of separation and the time you make your COBRA election decision, you may have to pay health premiums retroactively-from the time of separation. The first premium, for instance, will cover the entire time since your last day of coverage.

You should also be aware that it is your responsibility to pay for COBRA coverage even if you do not receive a monthly statement.

Checks returned for insufficient funds or checks that otherwise cannot be cashed do not constitute payment. Once coverage is lost, it cannot be reinstated.

Premiums adjust annual effective July 1.

You should also be aware that it is your responsibility to pay for COBRA coverage even if you do not receive a monthly statement.  Checks returned for insufficient funds or checks that otherwise cannot be cashed do not constitute payment. Once coverage is lost, it cannot be reinstated.

Click 2019-20 COBRA Retiree Rates effective 7/1/2019 for an easy to print version. There is no premium rate increase for July 1, 2019

Plan Election / Coverage Level Single Parent & Child Parent & Children Subscriber Spouse Family

Offered to employees represented by PFT 

PFT KEYSTONE-HMO $540.58 $756.81 $973.04 $1,081.15 $1,621.74
PFT PERSONAL CHOICE  25/35/50 $632.01 $884.83 $1,137.64 $1,264.05 $1,896.06

Offered to employees represented by Local 634 Unite HERE

KEYSTONE-HMO 15 $546.62 $764.99 $983.55 $1,092.83 $1,639.25
 

Offered to Non Represented employees and those represented by CASA

 PPO 20/30/70 w/prescription & vision $783.29 $1,262.41 $1,520.46 $1,649.49 $2,294.59
PERSONAL CHOICE Mod 320 prescription & vision $682.52 $1,121.32 $1,339.06 $1,447.93 $1,992.26

ANCILLARY COVERAGE (NO MEDICAL)

Dental $37.58 $67.63 $85.21 $67.63 $85.21
Prescription and Vision $138.18 $359.25 $359.25 $359.25 $359.25
Contact the employee Benefits Office if you do not see the plan your plan.

 

How do I use this benefit?

Your COBRA coverage is exactly the same coverage you had as an active employee. Usually you can use the same card, submit claims in the same way, and call the same Customer Service Number you used previously.

NOTE:  It is your responsibility to notify the School District Benefits office and Independence Blue Cross of alternate coverage so that Coordination of Coverage information can be updated.  By law, Medicare or coverage based on a spouse’s employment, is primary to COBRA coverage, meaning you must show your provider that insurance first and use those plan benefits before you can access the COBRA benefit.

 

Frequently Asked Questions

Who is Discovery Benefits?  Discovery Benefits is a firm contracted by the School District to handle the distribution of COBRA enrollment materials, process your enrollment and handle payment processing and monitor your eligibility.  You will be enrolled in the same Keystone or Personal Choice coverage you had through Independence Blue Cross.

How do I know when my coverage ends?  Your initial enrollment materials will list the number of months coverage for which you are eligible.   Each year you will receive coupons through the following June or the end of your eligibility, whichever is sooner.  Discovery Benefits will mail you a notice several months before your coverage ends.  You should plan in advance (see Alternatives to COBRA) so you are able to enroll in coverage with no break.

Who do I contact with a question?  Contact Discovery Benefits toll-free at (866) 451-3399 option 1, 2 regarding your enrollment, premium payment, changes to your enrolled dependents, or information on how long your coverage extends.  Continue to call the number on the back of your membership ID card (1-800-ASK-Blue) for information about participating providers, precertification, specific benefits, and claims issues.

When are my payments due?  Payments are due on the first day of each month and must be postmarked no later than the last day of the month for which they are due.   Keep in mind that your first payment may be for a period of more than one month.  It will cover the entire time since your last day of coverage.  Enclosed in your enrollment materials is a Premium Computation Form that lists the amount due based on the date your initial enrollment is received by Discovery Benefits.  It is your responsibility to pay for coverage even if you do not receive a monthly statement.

What is considered a late payment?  Payments are due on the first day of each month.  Payment received after that time are late.  If you do not send the full amount listed on the Premium Computation Form with your initial enrollment, your subsequent payments will all be late.

How can I get benefits and services during the interim between the end of my active coverage and the reinstatement of my COBRA coverage?  If you need services, like a Doctor’s visit, you may have to pay for the visit and then submit it for reimbursement. The doctor’s office may be willing to hold or resubmit the bill when your coverage is reactivated.

If I elect COBRA, am I obligated to pay for the full COBRA period?  No. You may drop COBRA coverage at the end of any month. You may also drop part of your coverage (i.e., dental, prescription and Vision) or dependents at any time. However, you may not add coverage or dependents except at Open Enrollment or in case of a family status change.

If I waive COBRA coverage during the election period, can I still get coverage at a later date?   If you or a qualified beneficiary waives COBRA coverage during the initial 60 day election period, he or she may revoke the waiver of coverage before the end of the election period. A beneficiary may then elect COBRA coverage.  If you are a qualified retiree, refer to our PA Acts 110/43 listed above.

What is a Qualifying Event?  Qualifying events are certain events that would cause an individual to lose health coverage. The type of qualifying event will determine who the qualified beneficiaries are and the amount of time that a plan must offer the health coverage to them under COBRA.

Qualifying Events for Employees:

  • Voluntary or involuntary termination of employment for reasons other than gross misconduct
  • Reduction in the number of hours of employment

Qualifying Events for Spouses:

  • Voluntary or involuntary termination of the covered employee’s employment for any reason other than gross misconduct
  • Reduction in the hours worked by the covered employee
  • Covered employee’s becoming entitled to Medicare
  • Divorce or legal separation of the covered employee
  • Death of the covered employee

Qualifying Events for Dependent Children:

  • Loss of dependent child status under the plan rules
  • Voluntary or involuntary termination of the covered employee’s employment for any reason other than gross misconduct
  • Reduction in the hours worked by the covered employee
  • Covered employee’s becoming entitled to Medicare
  • Divorce or legal separation of the covered employee
  • Death of the covered employee