In Plain Talk: What is COBRA?

In 1986, Congress passed the Consolidated Omnibus Budget Reconciliation Act (COBRA) to help you maintain uninterrupted health care coverage when a “life changing” event takes place. Life changing events include loss of current employment, divorce or legal separation, loss of dependent status for a child, or death of an insured individual. It requires companies with 20 or more employees to offer continuation of group health care coverage to workers and their eligible dependents who would otherwise lose group coverage.

You don’t automatically receive COBRA. You must elect to receive it, since not everyone who leaves a job needs it. Coverage can be continued for a specified period of time (typically 18 months) and the covered individual is responsible for paying the applicable premiums.

Who is eligible for COBRA coverage?

• You are, if you leave your job for any reason other than gross misconduct, or have a reduction in your work hours.
• Your covered dependents. For example, your spouse and/or minor children.
• A newborn or adopted child who joins your family while you are covered by COBRA.

Is a physical exam needed?

No.

What coverage is available?

Through COBRA, you can generally continue the same health care coverage and benefits you received under your employer’s plan prior to your departure. This may include medical, dental, vision, pharmacy, and/or behavioral care benefits. Check with your employer for more information.

What do I have to do?

If you become eligible for COBRA, you need to elect continuation of coverage by notifying your benefits manager within 60 days from the end of your employment, or other qualified loss of coverage, or when you receive notification of your COBRA rights, whichever is later.

How long can I receive COBRA coverage?

If you experience a qualifying event, you can continue your family’s coverage through COBRA for 18 or 36 months depending on the event.

Who pays for it?

The person who elects to receive COBRA continuation of coverage is responsible for payment. Premiums are due in monthly or quarterly installments according to the schedule you set. Your covered dependents can elect or decline continuation coverage independently.

How do my dependents or I qualify for an extension of standard COBRA coverage?

• If you or your dependent become totally disabled within 60 days of electing COBRA, you may be eligible for up to an additional 11 months of coverage for a total of 29 months. This extension is also available to any of your family members who are covered by COBRA at that time. If the person whose disability led to the COBRA coverage recovers from the disability, COBRA coverage would continue until the first day of the month 30 days after it was medically determined that the disability had ended.
• If you add a dependent newborn or adopted child to your family while you are covered by COBRA, the child is eligible for enrollment in his or her own 18-month COBRA plan for up to 18 months from the date you terminated employment.
• If you are Medicare-eligible before you terminate employment, your eligible dependents may continue COBRA coverage for 18 months from the date you terminate employment or retire, or 36 months from the date you became Medicare eligible, whichever is later.

What could cause COBRA coverage to end early?

• Enrollment in another group health plan (unless there’s a pre-existing condition for which coverage is limited or excluded under the new plan).
• Failing to pay the COBRA premium.
• Your former employer no longer offers any group health plan.
• You become eligible to receive Medicare benefits.

Still have a question?

Since the benefits available to you are determined by your employer’s plan and your COBRA eligibility status, please contact your employer’s benefits manager if you need assistance. He or she will be able to give you specific information and answers to your questions.