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Summary of Federal Laws

Employment

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Benefits Manager

Related Policies

Benefits

Miscellaneous Employment Laws

COBRA, Health Care Continuation Coverage Requirements (amended by the Health Insurance Portability and Accountability Act of 1996 (HIPAA))

29 U.S.C. § 1161 et seq., 26 USC § 4980B; 42 U.S.C. § 300-bb-1, et seq.

The Law: This law requires covered employers (20 or more employees) offering group health plans to provide employees and certain family members the opportunity to continue health coverage under the group health plan in a number of instances when coverage would otherwise have lapsed. The employee or qualified beneficiary may be charged 102% of the applicable premium for this benefit.

Notices Required:

There are several different notice obligations under the law. First, a health plan administrator has an obligation under the law to provide a general notice of COBRA rights to an employee and his/her spouse when health coverage begins. Second, the employer of a covered employee must notify the plan administrator within 30 days when a qualifying event occurs. A qualifying event includes:

  • an employee's termination of employment;
  • reduction of hours in employment;
  • death;
  • enrollment in Medicare; or
  • the employer's bankruptcy filing.

Third, the qualified beneficiary (employee or his/her spouse or dependent) must provide notice (within 60 days) to the plan administrator of a divorce, legal separation, child losing dependent status, second qualifying event, or Social Security disability determination. Fourth, the plan administrator in turn must notify (within 14 days) the qualified beneficiary ((notice to spouse covers dependents residing with that spouse) of his/her COBRA rights. See 29 CFR § 1166 for further permutations of the rules, for example, how determination of disability affects the timing under the third notice requirement.

Qualified beneficiaries have 60 days to elect continuation coverage. The maximum period that this continued coverage must be provided is generally 18 months, but in some cases it is 36 months. Under a new law (The Trade Act of 2002) there will be a second 60 day election period for individuals who become eligible for trade adjustment assistance.See the proposed regulations linked below.

The employer must keep detailed records of COBRA notifications, including the dates sent, and detailed records of COBRA rejections or acceptance. Failure to comply with the law subjects the employer to excise taxes, in addition to damages under ERISA, as well as possible attorney's fees and the liability for any of the beneficiary's medical expenses that were due to the gap in coverage.


Notice of Proposed Rulemaking for Health Care Continuation Coverage, 79 Fed. Reg. 26192, May 7th, 2014

These proposed regulations amend paragraph (g) of § 2590.606-1 and paragraph (g) of § 2590.606-4 and delete the two appendices containing the model notices to better facilitate provision of updated model election notices and solicit comment before promulgation of final regulations.These updated notices reflect that coverage is now available in the Marketplace and the updated model election notice provides information on special enrollment rights in the Marketplace.

Resources

 

Updated Model COBRA Notices (May 2014)


 

 

 

 

 

updated 7-10-14