COBRA Administration

Notice of COBRA election notice includes the following information:

• A written explanation of the procedures for electing COBRA
• The date by which the election must be made
• How to notify the plan administrator of the election
• The date coverage will begin,
• The maximum period of continuation coverage
• The monthly premium amount,
• The due date for the monthly payments
• Any applicable premium amount due for a retroactive period of coverage
• The address to which to send premium payments
• A qualified beneficiary's rights and obligations concerning extensions of coverage and the basis for early termination of the period of coverage.
• Plans also must provide a Summary of Benefits and Coverage (SBC) that accurately describes the benefits and coverage under the applicable plan. The SBC is a uniform template that uses clear, plain language to summarize key features of the plan, such as covered benefits, cost-sharing provisions, and coverage limitations. Plans and issuers must provide the SBC to participants and beneficiaries at certain times (including with written application materials, at renewal, upon special enrollment, and request).

Yes. This means that if you have coverage, you don't have to pay the fee that people without coverage must pay. The applicant (person requesting a review of a denial of premium assistance) may either be the former employee or a member of the employee's family eligible for continuation coverage or the premium assistance through an employment-based health plan. Employee and their family members may each elect to continue health coverage under COBRA, request the premium assistance, and require a review of a denial of premium assistance.

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's employment for any reason other than gross misconduct.
• Reduction in the hours worked by the covered employee.
• Covered employee becomes entitled to Medicare.
• Divorce or legal separation of the spouse from the covered employee.
• 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. Under the Patient Protection and Affordable Care Act, plans that offer coverage to children on their parents’ plan must make the coverage available until the adult child reaches the age of 26.

A group health plan cannot require payment for any period of COBRA continuation coverage earlier than 45 days after the day on which the qualified beneficiary made the initial election for continuation coverage.

The continuation coverage must be identical to the coverage currently available under the plan to similarly situated individuals who are not receiving continuation coverage. Generally, this is the same coverage claims denials also apply.

Any changes to the plan's terms that apply to situate active employees similarly and their families will also apply to qualified beneficiaries receiving COBRA continuation coverage. Suppose a child is born to or adopted by a covered employee during a period of continuation coverage. In that case, the child is automatically considered to be a qualified beneficiary receiving continuation coverage. The plan must allow the child to be added to the continuation coverage.

The Consolidated Omnibus Budget Reconciliation Act of 1985 created a Federal Law requiring most employers with more than 20 employees who offer group health care coverage to give their employees, spouse, and dependents option to continue their health care coverage when a loss in coverage occurs. COBRA coverage is the same coverage the employee had when they were actively working for the employer.

However, the employee is responsible for 100 percent of the premiums, plus possibly a two percent administration fee. COBRA provides former employees, retirees, spouses, former spouses, and dependent children the right to temporary health coverage at group rates. Many people do not understand the laws surrounding COBRA eligibility and their rights under the law.

It is a Federal Program that gives an employee the ability to maintain group medical coverage if lost due to termination, disability, death of the covered employee, or another qualifying event. The COBRA statutes apply to businesses with 20 or more employees. only that the insurance is available. For COBRA, group medical coverage:

• It does not matter if the former employer pays for the premium, in whole or in part, for its employees, defined loosely. It includes everything from Preferred Provider policies, HMO coverage, self-funded plans to any variation of and several states have different statutes requiring businesses fewer than twenty people comply with COBRA law. Determination of eligibility depends on the event that caused the loss of benefits.