The U.S. Department of Labor (DOL) and the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS), have established appeal procedures for individuals who have been denied federal COBRA premium assistance under the American Recovery and Reinvestment Act of 2009 (ARRA). Under these new procedures, the participant will appeal directly to the agencies. No additional action is required by employers unless the agency contacts the employer for additional information.
Note that the DOL and CMS review denials for two distinct groups, depending upon how an individual qualifies for coverage and who provides that coverage. Individuals who believe they are eligible for the subsidy with respect to continuation coverage under a private-sector health plan (with 20 or more employees) should submit an application for review to the DOL. Government employees (federal and non-federal) and individuals covered by state “mini COBRA” laws (in general, insured health plans offered by employers with fewer than 20 employees) who believe they are eligible for the subsidy should submit an application for review to CMS.
To request DOL review, individuals must complete the ten page “Application for Expedited Review of Denial”, which is available on the DOL website at www.dol.gov/cobra. The form can be completed and submitted online or the applicant may print the application and fax or mail it to the DOL. The DOL help desk phone number is (866) 444-3272.
To request CMS review, individuals must complete a similar form available at www.continuationcoverage.net. Unlike the DOL form, the CMS form cannot be completed online and must be submitted by mail, fax, or hand delivery. The CMS COBRA premium assistance help desk can be reached by phone at (866) 400-6689.