FAQs About COBRA
Continuation Health Coverage
How long does COBRA coverage last?
COBRA establishes required periods of coverage for
continuation health benefits. A plan, however, may provide longer
periods of coverage beyond those required by COBRA. 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.
Coverage begins on the date that coverage would
otherwise have been lost by reason of a qualifying event and will end at
the end of the maximum period. It may end earlier if:
- Premiums are not paid on a timely basis
- he employer ceases to maintain any group health
plan
- After the COBRA election, coverage is obtained with
another employer group health plan that does not contain any exclusion
or limitation with respect to any pre-existing condition of such
beneficiary. However, if other group health coverage is obtained
prior to the COBRA election, COBRA coverage may not be discontinued,
even if the other coverage continues after the COBRA election.
- After the COBRA election, a beneficiary becomes
entitled to Medicare benefits. However, if Medicare is obtained
prior to COBRA election, COBRA coverage may not be discontinued, even
if the other coverage continues after the COBRA election.
Although COBRA specifies certain periods of time that
continued health coverage must be offered to qualified beneficiaries,
COBRA does not prohibit plans from offering continuation health coverage
that goes beyond the COBRA periods.
Some plans allow participants and beneficiaries to
convert group health coverage to an individual policy. If this
option is generally available from the plan, a qualified beneficiary who
pays for COBRA coverage must be given the option of converting to an
individual policy at the end of the COBRA continuation coverage period.
The option must be given to enroll in a conversion health plan within 180
days before COBRA coverage ends. The premium for a conversion policy
may be more expensive than the premium of a group plan, and the conversion
policy may provide a lower level of coverage. The conversion option,
however, is not available if the beneficiary ends COBRA coverage before
reaching the end of the maximum period of COBRA coverage.
Who pays for COBRA coverage?
Beneficiaries may be required to pay for COBRA
coverage. The premium cannot exceed 102 percent of the cost to the
plan for similarly situated individuals who have not incurred a qualifying
event, including both the portion paid by employees and any portion paid
by the employer before the qualifying event, plus 2 percent for
administrative costs.
For qualified beneficiaries receiving the 11 month
disability extension of coverage, the premium for those additional months
may be increased to 150 percent of the plan's total cost of coverage.
COBRA premiums may be increased if the costs to the
plan increase but generally must be fixed in advance of each 12-month
premium cycle. The plan must allow you to pay premiums on a monthly
basis if you ask to do so, and the plan may allow you to make payments at
other intervals (weekly or quarterly).
The initial premium payment must be made within 45 days
after the date of the COBRA election by the qualified beneficiary.
Payment generally must cover the period of coverage from the date of COBRA
election retroactive to the date of the loss of coverage due to the
qualifying event. Premiums for successive periods of coverage are
due on the date stated in the plan with a minimum 30-day grace period for
payments. Payment is considered to be made on the date it is sent to
the plan.
If premiums are not paid by the first day of the period
of coverage, the plan has the option to cancel coverage until payment is
received and then reinstate coverage retroactively to the beginning of the
period of coverage.
If the amount of the payment made to the plan is made
in error but is not significantly less than the amount due, the plan is
required to notify you of the deficiency and grant a reasonable period
(for this purpose, 30 days is considered reasonable) to pay the
difference. The plan is not obligated to send monthly premium
notices.
COBRA beneficiaries remain subject to the rules of the
plan and therefore must satisfy all costs related to co-payments and
deductibles, and are subject to catastrophic and other benefit limits.
If I elect COBRA, how much do I pay?
When you were an active employee, your employer may
have paid all or part of your group health premiums. 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.
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 layoff and the time you make the COBRA
election decision, you may have to pay health premiums retroactively-from
the time of separation from the company. The first premium, for
instance, will cover the entire time since your last day of employment
with your former employer.
You should also be aware that it is your responsibility
to pay for COBRA coverage even if you do not receive a monthly statement.
Although they are not required to do so, some employers
may subsidize COBRA coverage.
Can I receive COBRA benefits while on FMLA leave?
The Family and Medical Leave Act, effective August 5,
1993, requires an employer to maintain coverage under any group
health plan for an employee on FMLA leave under the same conditions
coverage would have been provided if the employee had continued working.
Coverage provided under the FMLA is not COBRA coverage, and FMLA leave is
not a qualifying event under COBRA. A COBRA qualifying event may
occur, however, when an employer's obligation to maintain health benefits
under FMLA ceases, such as when an employee notifies an employer of his or
her intent not to return to work.
Further information on FMLA is available from the
nearest office of the Wage and Hour Division, listed in most telephone
directories under U.S. Government, U.S. Department of Labor, Employment
Standards Administration.
What is the Federal Government's role in COBRA?
COBRA continuation coverage laws are administered by
several agencies. The Departments of Labor and Treasury have
jurisdiction over private-sector health group health plans. The
Department of Health and Human Services administers the continuation
coverage law as it affects public-sector health plans.
The Labor Department's interpretive and regulatory
responsibility is limited to the disclosure and notification requirements
of COBRA. If you need further information on your disclosure or
notification rights under a private-sector plan, or about ERISA generally,
telephone EBSA's Toll-Free number at:
1.866.444.3272, or write to:
U.S. Department of Labor
Employee Benefits Security Administration
Division of Technical Assistance and Inquiries
200 Constitution Avenue NW,
Suite N-5619
Washington, DC 20210
The Internal Revenue Service, Department of the
Treasury, has issued regulations on COBRA provisions relating to
eligibility, coverage and premiums in 26 CFR Part 54, Continuation
Coverage Requirements Applicable to Group Health Plans. Both
the Departments of Labor and Treasury share jurisdiction for enforcement
of these provisions.
The Center for Medicare and Medicaid Services offers
information about COBRA provisions for public-sector employees. You
can write them at this address:
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Mail Stop C1-22-06
Baltimore, MD 21244-1850
Tel 1.877.267.2323 x61565
I am a federal employee. Can I receive benefits
under COBRA?
Federal employees are covered by a law similar to
COBRA. Those employees should contact the personnel office serving
their agency for more information on temporary extensions of health
benefits.
Am I eligible for COBRA if my company closed or went
bankrupt and there is no health plan?
If there is no longer a health plan, there is no COBRA
coverage available. If, however, there is another plan offered by
the company, you may be covered under that plan. Union members who
are covered by a collective bargaining agreement that provides for a
medical plan also may be entitled to continued coverage.
How do I find out about COBRA coverage and how do I
elect to take it?
Employers or health plan administrators must provide an
initial general notice if you are entitled to COBRA benefits. You
probably received the initial notice about COBRA coverage when you were
hired.
When you are no longer eligible for health coverage,
your employer has to provide you with a specific notice regarding your
rights to COBRA continuation benefits.
Employers must notify their plan administrators within
30 days after an employee's termination or after a reduction in hours that
causes and employee to lose health benefits.
The plan administrator must provide notice to
individual employees of their right to elect COBRA coverage within 14 days
after the administrator has received notice from the employer.
You must respond to this notice and elect COBRA
coverage by the 60th day after the written notice is sent or the day
health care coverage ceased, whichever is later. Otherwise, you will
lose all rights to COBRA benefits.
Spouses and dependent children covered under your
health plan have an independent right to elect COBRA coverage upon your
termination or reduction in hours. If, for instance, you have a
family member with an illness at the time you are laid off, that person
alone can elect coverage.
Deep In Debt? — Call 1800 DEBT.COM — Get Help Today!
|
