What protection is available if you are no longer employed?

The first and best option is to maintain your group insurance through your prior employer. This information will assist you in understanding the COBRA and the protection that it provides.

What is COBRA?

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires most employers with group health plans to offer employees the opportunity to continue temporarily their group health care coverage under their employer's plan if their coverage otherwise would cease due to termination, layoff, or other change in employment status (referred to as "qualifying events").

What time periods apply to this protection?

    Up to 18 months for covered employees.
    Up to 29 months is available to employees who are determined to have been disabled at any time during the first 60 days of COBRA coverage.
    Up to 36 months for spouses and dependents facing a loss of employer-provided coverage due to an employee's death, a divorce or legal separation.

What is the definition of a Covered Employee?

Covered employee "means an individual who is (or was) provided coverage under a group health plan by virtue of the performance of services by the individual for 1 or more persons maintaining the plan. This definition is expansive and includes retirees, independent contractors, self-employed persons and partners of a partnership.

What Plans Are Subject to COBRA?

Virtually all group health plans maintained by employers for their employees are subject to COBRA's provisions, include group health plans of corporations, partnerships, tax exempt organizations, state and local governments. This also includes Health Care Spending Accounts.

What Plans Are Not Subject to COBRA?

Small employer plans with fewer than 20 employees
Federal Government's Group Health Plan (separate protection is available)

What is the purpose of the Initial COBRA Notice?

The Initial COBRA notice informs the plan participants (and his or her spouse if any) their rights under COBRA "at the time of commencement of the coverage under the plan."

Within what time period does the Qualified Beneficiary have the option of electing COBRA?

A qualified beneficiary may elect COBRA coverage at any time within 60 days after the date plan coverage terminates, or, if later 60 days after the date of the notice to the qualified beneficiary from the plan administrator. The 60-day period permits a qualified beneficiary to "adopt a wait-and-see approach to continued coverage, and then elect if and when medical care is required during the election period. If the plan administrator has not sent the notice of qualifying event, the election period remains open. The 60 day period is a minimum.

What are the Premium Payment Deadlines regarding COBRA coverage?

A plan may not require any payment until 45 days after the qualified beneficiary's initial election. If a qualified beneficiary fails to make the initial premium payment within the 45-day period, the plan administrator may terminate the COBRA coverage. Thereafter, payments are due on the first of each month, subject to a 30-day grace period.

What are the benefits of COBRA coverage?

Although expensive COBRA coverage is generally available at a rate lower than individual insurance.

 

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