Understanding COBRA Eligibility: Who Qualifies and When?

Understanding the intricacies of the Consolidated Omnibus Budget Reconciliation Act (COBRA) can be challenging for employers and employees alike. It may be especially daunting when trying to understand who qualifies for COBRA coverage and when they qualify. 

What is COBRA?

COBRA is a federal law enacted in 1985 that requires employers with 20 or more employees to offer continuation coverage. This applies only to employees and their dependents whose coverage would end due to qualifying events (QEs). These events may include a job loss, a reduction in work hours, a divorce, or other life events.

Who Qualifies for COBRA?

COBRA eligibility applies to employees and dependents facing events that result in the loss of their health insurance coverage.

Employees

Employees covered under an employer’s group health plan the day before a qualifying event may be eligible for COBRA coverage. This includes full-time, part-time, and temporary employees who meet the eligibility criteria for the employer’s health insurance plan.

Dependents

In addition to employees, COBRA allows qualified dependents of covered employees to continue their health insurance coverage. Qualified dependents may include a covered employee’s spouse, children, and other eligible dependents covered under the plan before the qualifying event occurred.

When does COBRA eligibility occur?

COBRA eligibility is triggered by specific qualifying events that result in the loss of health insurance coverage. These qualifying events may include:

Termination of Employment

When an employee’s employment is terminated for reasons other than gross misconduct, they and their eligible dependents may qualify for COBRA continuation coverage.

Reduction in Work Hours

If an employee experiences a reduction in work hours that causes them to lose eligibility for employer-sponsored health insurance coverage, they and their eligible dependents may qualify for COBRA.

Employees who experience a divorce or legal separation, their former spouse and eligible dependents may qualify for COBRA if they lose plan coverage as a result of these actions.

Death of the Covered Employee

Eligible dependents may qualify for COBRA continuation coverage if they lose coverage as a result of the employee’s death.

A Child No Longer Qualifies as a Dependent

When a dependent child becomes ineligible for plan coverage due to age, marriage, or another reason, they may qualify for COBRA continuation coverage.

What is the COBRA election period?

Employers must provide individuals who qualify for COBRA with a notice of their rights and an opportunity to elect continuation coverage once a qualifying event occurs. This notice typically includes information about the COBRA election period. This is the window of time during which individuals can choose whether or not to elect COBRA.

The COBRA election period is generally 60 days from the later of the date of the qualifying event or the date the individual receives the COBRA election notice. During this period, individuals must decide whether to elect COBRA. They must also submit the necessary paperwork and premium payments to the employer or plan administrator.

How are COBRA premiums calculated?

COBRA continuation coverage is not free. Those who elect COBRA typically pay the full cost of the premium plus a 2% administrative fee. This can be significantly more expensive than the cost of coverage under the employer’s group health plan. This is because COBRA recipients pay both the part of the total premium that active employees pay for the same coverage as well as the part that employers pay for their active employees.

In Summary

COBRA serves as a crucial safety net for employees and their dependents, offering peace of mind and continuity of healthcare coverage during periods of change. By providing timely and accurate information about COBRA rights and options, employers can empower individuals to make informed decisions about their healthcare coverage and maintain financial security during challenging times. 

DataPath, Inc. has been a full-service TPA business solutions provider for four decades. Our cloud-based Summit platform is the industry’s first all-in-one solution for CDH, HSA, Well-Being, COBRA, and Billing administration. Please enter your email (above right) to be notified when new blog articles are published.

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