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COBRA Benefits

 
COBRA CONTINUATION HEALTH CONVERAGE

The landmark Consolidated Omnibus Budget Reconciliation Act (COBRA) which was effective in 1986, amends the Employee Retirement Income Security Act, the Internal Revenue Code and the Public Health Service Act to provide continuation of group health coverage that otherwise might be terminated.

When you were an active employee, your employer may have paid all or part of your group health premiums. However, under COBRA, as a former employee no longer receiving benefits, you will usually pay the entire premium amount, that is, the portion of the premium that you paid as an active employee and the amount of the contribution made by your employer. In addition, there may be a 2 percent administrative fee.

FAQs For Employees About COBRA Continuation Health Coverage (which information is provided by the Department of Labor):  Information about Cobra Benefits

 

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.
COBRA outlines how employees and family members may elect continuation coverage. It also requires employers and plans to provide notice.
There are three elements to qualifying for COBRA benefits.  COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying events:

 

Plan Coverage

Group health plans for employers with 20 or more employees on more than 50 percent of its typical business days in the previous calendar year are subject to COBRA.  Both full and part-time employees are counted to determine whether a plan is subject to COBRA. Each part-time employee counts as a fraction of an employee, with the fraction equal to the number of hours that the part-time employee worked divided by the hours an employee must work to be considered full-time.

Qualified Beneficiaries

A qualified beneficiary generally is an individual covered by a group health plan on the day before a qualifying event who is either an employee, the employee's spouse, or an employee's dependent child.  In certain cases, a retired employee, the retired employee's spouse, and the retired employee's dependent children may be qualified beneficiaries.  In addition, any child born to or placed for adoption with a covered employee during the period of COBRA coverage is considered a qualified beneficiary.  Agents, independent contractors, and directors who participate in the group health plan may also be qualified beneficiaries.

Qualifying Events

"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. A plan, at its discretion,  may provide longer periods of continuation coverage.

  • 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 (same as for spouses with one addition)
    • Loss of dependent child status under the plan rules

 

COBRA beneficiaries generally are eligible for group coverage during a maximum of 18 months for qualifying events due to employment termination or reduction of hours of work.  Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.

 
 
Samole Law Firm, P.A
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