EBSA will implement a new program for the review of employee appeals of COBRA Premium Assistance denials. The process for handling the requests for review of COBRA Premium Assistance denials includes intake, technical review and final determination.
EBSA’s Office of Participant Assistance (OPA) will be responsible for overseeing the day-to-day operations of the COBRA premium assistance appeal program. OPA will report daily, weekly and monthly program results and ensure that the intake process adheres to EBSA’s established quality assurance program and that EBSA is responding in a timely fashion. The Technical Assistance and Inquiry System (TAIS), as amended, will provide timeliness statistics to be used for evaluating the performance data for leadership review and consideration (e.g. applications received, processed, resolved, numbers of days to respond, etc). As necessary and consistent with Recovery and Risk Mitigation plans, standard operating procedures established nationwide to implement this program may be altered and/or resources redirected to ensure Recovery Act compliance. For example, EBSA estimates that it will receive 5,000 applications per month but has created a flexible program that may be scaled up (or down) based on actual experience.
EBSA will oversee management of the Recovery Act funds, consistent with Recovery Act reporting and accountability guidance received from the Department and is already reporting to the Department and OMB daily, weekly, and monthly on Recovery Act activities. EBSA has developed quality assurance standards, methods for measuring program success - including provisions in the contract that require the contractor to develop a quality assurance program, expanded the inquiry tracking database that will produce real time data, hired temporary staff and trained existing and new staff. Management and program oversight to the entire intake and review process will be employed to ensure that applications are being processed timely (within 15 business days) and in accordance with established procedures.
A dedicated COBRA website has been developed that includes the latest guidance on the Recovery Act COBRA provisions, model notices, FAQs, fact sheets & publications and eventually the e-file and paper filing instructions for requesting an expedited review of COBRA subsidy denials. This site also meets the intent of the Recovery Act to provide a transparent means of reporting results.
An aggressive outreach and education program was implemented to assist employers, workers, health plan providers or workers facing plant closures, layoffs, or bankruptcies. The plan provides critical and timely information related to eligibility and enrollment in these programs as needed to ensure continuation of their health benefits under COBRA. Outreach activities include, but are not limited to, educational materials and publications and video presentations to help participants understand their new rights and protections under the Recovery Act legislation. EBSA will conduct customer satisfaction surveys as appropriate, following webcasts or onsite participant outreach activities.