COBRA
is the LAW
Congress passed the landmark Consolidated Omnibus Budget Reconciliation
Act (COBRA) health benefit provisions in 1986. The law 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.
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.
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:
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
To be eligible for COBRA coverage, you must have been enrolled in your employer's health
plan when you worked and the health plan must continue to be in effect for active employees. 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 law generally covers health plans maintained by private-sector employers with 20
or more employees, employee organizations, or state or local governments.
Excerpts
from the US Department of Labor
http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html