The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and
their families who lose their health benefits the right to choose to continue
group health benefits under their existing health plan for limited periods of
time.
COBRA requires continuation coverage to be offered to covered employees,
their spouses, their former spouses, and their dependent children when group
health coverage would otherwise be lost due to certain specific events. Those
events include the death of a covered employee, termination, or reduction in the
hours of a covered employee for reasons other than gross
misconduct, divorce or legal separation from a covered employee, a covered
employee’s becoming entitled to Medicare, and a child’s loss of dependent status
(and therefore coverage) under the plan.
Under COBRA, a group health plan is considered an arrangement in which an employer
provides employees and their dependents with medical
care, whether it is provided through insurance, by a health maintenance
organization, out of the employer’s assets on a pay-as-you-go basis, or
otherwise".
Standard medical care coverage under COBRA includes:
- Inpatient and outpatient hospital care;
- Physician care;
- Surgery and other major medical benefits;
- Prescription drugs; and
- Dental and vision care.
Eligibility
There are three basic requirements that must be met in order for you to be
entitled to elect COBRA continuation coverage:
- Your group health plan must be covered by COBRA;
- A qualifying event must occur; and
- You must be a qualified beneficiary for that event.
Qualifying events are events that cause an individual to lose his or
her group health coverage. The type of qualifying event determines who the
qualified beneficiaries are for that event and the period of time that a plan
must offer continuation coverage. COBRA establishes only the minimum
requirements for continuation coverage.
A plan may always choose to provide longer periods of continuation coverage.
The following are qualifying events for a covered employee if they
cause the covered employee to lose coverage:
- Termination of an employee for any reason other than
“gross misconduct”; or
- Reduction of hours worked by the covered employee.
The following are qualifying events for the spouse and dependent child of a
covered employee if they cause the spouse or dependent child to lose coverage:
- Termination of the covered employee for any reason other
than “gross misconduct”;
- Reduction of hours worked by the covered employee;
- Covered employee becomes entitled to Medicare;
- Divorce or legal separation of the spouse from the covered employee; or
- Death of the covered employee.
In addition to the above, the following is a qualifying event for a dependent
child of a covered employee if it causes the child to lose coverage:
- Loss of “dependent child” status under the plan rules.
Information about Social Security benefit programs:
- Social Security Disability Insurance
- Supplemental Security Income
- Regular disability benefits
- Widow/widower disability benefits
- Adult disabled child benefits
- Blind disability benefits
Are you eligible for COBRA? If you or a loved one need assistance with your
COBRA claim or appeal, please call us at 1.800.966.4999 or fill out the
form on the right side of this page to speak with a member of our team.
