Frequently Asked Questions  >  COBRA


COBRA
  1. What is COBRA ?

  2. Which employers must comply ?

  3. What is a Qualifying Event (QE) for COBRA continuation ?

  4. How was the Premium Assistance for COBRA and state continuation extended under the 2010 Defense of Defense Appropriations Act, P.L. 111-118 (H.R 3326) signed 12-19-2009, the Temporary Extension Act (TEA)  H.R. 4691 signed 3-2-2010 and H.R. 4851, the Continuing Extension Act ?

  5. Is the employer required to send a notice when the ARRA subsidy is ending ?

  6. Must an employer offer COBRA continuation if the qualified beneficiary is eligible or enrolled in Medicare ?

  7. How long does the employer have to mail the Election Notice when a Qualifying Event has occurred?


  8. Please define Involuntary Termination (IT) in the context of ARRA (The American Recovery & Reinvestment Act of 2009)

  9. Who is a Qualified Beneficiary (QB) and how long does a Qualified Beneficiary have to elect coverage ?

  10. Are employees that the employer does not consider full time counted to determine the 20 or more employees ?

  11. Which employers are exempt ?

  12. Who pays the premium and to whom ?

  13. What is recommended to an employer who receives a COBRA premium check that bounces or is rejected for insufficient funds ?

  14. Can the member(s) remain on COBRA even if they are eligible for other group coverage ?

  15. Who is entitled to benefits ?

  16. Are Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs) subject to COBRA ?

  17. Are Domestic Partners, Civil Union Partners, and NJs Dependents to 31 considered  eligible for COBRA continuation as spouses/dependents ?

  18. Am I eligible for COBRA if my company closed or went bankrupt and there is no health plan?

  19. What is a Qualifying Event ?

  20. May a company that is no longer in business offer COBRA ?

  21. What are the maximum durations of continuation of coverage ?

  22. Do Reservists have expanded continuation benefits ?

  23. May a person on COBRA add a dependent ?

  24. Can someone eligible for Medicare elect COBRA ?

  25. Must a new plan offering be offered to a COBRA continuee ?

  26. What if the continuee moves outside the service area of the plan ?

  27. Is there a special COBRA law in New York for groups that do not qualify for Federal COBRA ?

  28. What are the penalties applicable for non-compliance with ARRA, The COBRA Premium Assistance Provisions of Title III ?

  29. Where can I obtain further information?





  1. What is COBRA ?


    COBRA is a Federal Law whereby terminated employees, those who lose coverage because of reduced work hours, and / or covered dependents may be able to continue on the group medical, dental, vision, HRA plan(s) for limited periods of time.  If entitled to benefits, the health plan must provide a notice of rights and allow the qualified beneficiary 60 days to elect to continue.  Once selected, the continuee(s) pays the full premium (100% of the employer plus 100% of the employee contribution) and the employer may impose a 2% surcharge.  Persons extending coverage to 29 months due to Medicare disability may be charged 150% of the total premium.


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  2. Which employers must comply ?


    Generally,  employers, including self-insured employers, as well as non-profit organizations with 20 or more on payroll (including full time, part time, union and non-union) for more than 50% of business days in the preceding CALENDAR year must offer COBRA continuation of the group health plan.
     
    The employer determines what full time hours are (up to 40 hours for Federal COBRA purposes) and those working less than full time count as fractions. 
    Example: A company has 10 full time 40 hour per week employees and 30 working a total number of 400 hours.
    40 full time hours divided into 400 part time hours equals 10. The 10 full time plus 10 equivalent to full time equals 20 on the payroll. If there have been 20 for at least 50% of the typical business days of the preceding year, the group must comply with COBRA.
    Note: IRS's COBRA regulations specifically provide that self-employed individuals, independent contractors, and directors are not counted in determining if the employer is subject to COBRA.  Keep in mind however that NJs definition of Independent Contractors for eligibility for small group plans may differ from the IRS definition.
    Controlled groups: The controlled group rules operate to treat related employers (such as those having a parent-subsidiary relationship or certain levels of common ownership) as a single employer. These controlled group rules apply in the determination of whether an employer is exempt from COBRA under the small-employer exemption. Thus, although an employer may employ fewer than 20 employees, it will not qualify for the small-employer exemption if, together with a related company in the same controlled group, there are 20 or more employees. It also is important to note that foreign corporations are not excluded from membership in a controlled group of corporations.


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  3. What is a Qualifying Event (QE) for COBRA continuation ?


    Qualifying events are events that cause an individual to lose group health coverage. The type of event determines the period of time a plan must offer continuation coverage.
    Following are events for employees:
     
    -Termination of the covered employee's employment for any reason other than "gross misconduct"; or
    -Reduction of hours that results in the loss of eligibility for health coverage. (Note: a reduction of hours without an involuntary termination is NOT an event for premium assistance/subsidy)
     
    Following are events for a spouse or dependent child(ren):
     
    -Termination of the covered employee's employment for any reason other than "gross misconduct";
    -Reduction of hours resulting in a loss of health coverage;
    -Covered employee becomes entitled (enrolled) in Medicare (and who loses coverage as a result). This includes the scenario where the active at work employee terminates from the health plan to fully enroll onto Medicare. The spouse/ dependents now have a Qualifying Event;
    -Divorce of legal separation of the spouse from the covered employee; or
    -Death of the covered employee.
     
    In addition, a loss of dependent child status under the plan rules is a qualifying event.
     


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  4. How was the Premium Assistance for COBRA and state continuation extended under the 2010 Defense of Defense Appropriations Act, P.L. 111-118 (H.R 3326) signed 12-19-2009, the Temporary Extension Act (TEA)  H.R. 4691 signed 3-2-2010 and H.R. 4851, the Continuing Extension Act ?


    The 2010 DOD Act extends the eligibility period for the COBRA premium reduction for an additional two months (through 2-28-10) and the maximum period for receiving the subsidy for an additional six months (from nine to 15 months).

    TEA signed on March 2 extends involuntary terminations through March 31, 2010.

    This measure also created a new class of eligible individuals for the subsidy. It provides COBRA and subsidy eligibility for those employees who first lost health plan coverage due to a reduction in hours and then were involuntarily terminated after the date of the act's effective date. The involuntary termination of employment for those employees who were previously covered but lost coverage due to a reduction in hours is now a qualifying event, and that reduction of hours is now the start of a person’s COBRA coverage eligibility, not the involuntary termination. The COBRA coverage period is measured from the date of the reduction of hours, but premiums do not have to be paid for COBRA coverage between the reduction of hours and the involuntary termination.  Notices will have to be provided to eligible individuals within 60 days of the date of involuntary termination date with information regarding this extension and special COBRA enrollment period. The new change to the law does not impact the length of the subsidy, which remains at 15 months. For more information, visit the DOL's website.

    http://www.dol.gov/ebsa/newsroom/fsCOBRApremiumreduction.html  

    H.R. 4851 was signed by President Obama on April 15. It extends premium assistance to involuntary terminations through May 31, 2010

    see here for the latest changes http://www.savoyassociates.com/NewsDetailPremium.aspx?id=2787

    The DOL Fact Sheet regarding the 2010 DOD extension states:

    "Individuals who had reached the end of the reduced premium period before the legislation extended it to 15 months will have additional time to pay the reduced premiums related to the extension. To continue their coverage they must pay the 35% of premium costs by February 17, 2010 (within 60 days of the enactment date of December 19, 2009) or within 30 days of when the extension notice is provided (postmarked) by their plan administrator."

    The Act further makes a technical correction stating the eligibility for the subsidy is based on timing of the Qualifying Event, the involuntary termination, not the date of eligibility for COBRA or state continuation.

    Example: an individual involuntarily terminated February 1, 2010 but covered through February 28 is still eligible for the subsidy although the continuation eligibility date is March 1, 2010.

    Notices can be found here: http://www.dol.gov/ebsa/COBRAmodelnotice.html.

    Below were the eligibility rules under The American Recovery & Reinvestment Act of 2009 signed February 17, 2009.

    • Employees who were involuntarily terminated between September 1, 2008 and December 2009 may receive a subsidy and will pay 35% of the continuation premium for a maximum of 9 months per event.  Note that the termination date and the eligibility date MUST occur prior to January 1, 2010 which means that if the member is covered through December 31, they are NOT eligible for the ARRA subsidy.
    • The subsidy ends if  1- the Assistance Eligible Individual becomes eligible for any other group health plan, Note: eligibility for coverage by TRICARE does not end the individual's of premium subsidy (clarified by IRS on 6-4-2009) 2-becomes eligible for Medicare, or 3- 18 months from the original termination date has expired. Each termination event would qualify the AEI for a 9 month subsidy. The terminations must occur before Jan 1, 2010.
      Example: Involuntarily terminated (IT’d) October 1, 2008. Subsidy starts March 1, 2009.  Person gets a job w/ benefits May 1, 2009.  Person is laid off October 1, 2009. They are once again eligible for a full 9 months subsidy even though they used 2 months (March and April 2009). This is assuming the income is below $125k and s/he is not eligible for any other group plan or Medicare.
    • Employers in groups subject to Federal COBRA may permit the AEI to switch to a plan of same or lesser premium that is also available to active at work employees.
    • For groups subject to Federal COBRA, the employer pays 65% and is reimbursed via payroll taxes on Form 941.  Under state continuation plans, the carrier pays the 65% and is reimbursed via its payroll taxes.  See here for full details http://www.savoyassociates.com/NewsDetail.aspx?id=2019
    • Involuntary termination is an employer initiated termination for other than gross misconduct. A reduction of hours may be defined as involuntary if the employee subsequently terminates employment. Treasury recommends that the employer err on the side of caution and subsidize if in doubt.
    You may contact Joan Fusco, Director, Research & Education at joanfusco@savoyassociates.com for further information. Her cellular number is 848-391-3700.


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  5. Is the employer required to send a notice when the ARRA subsidy is ending ?


    There is no requirement but it is recommended.


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  6. Must an employer offer COBRA continuation if the qualified beneficiary is eligible or enrolled in Medicare ?


    Yes. Supreme Court ruling Geissal vs Moore of 1994 says persons eligible or enrolled in Medicare on the day of the qualifying event must be offered COBRA. Conversely, COBRA coverage will end when a person becomes eligible or enrolled in Medicare while being covered under COBRA. Keep in mind that regardless of the TEFRA status of the group, Medicare is always primary once the member elects COBRA.


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  7. How long does the employer have to mail the Election Notice when a Qualifying Event has occurred?



    The Employer has 14 days to mail the notice.  If the employer uses a COBRA administrator, an additional 30 days is given to provide the notice. The DOL sample notice is in our forms section. Several courts have taken the position that an employer who is also the administer has 44 days to provide a qualifying event notice.
     
    The updated notices under the Temporary Extension Act signed March 2, 2010 are available here http://www.dol.gov/ebsa/COBRAmodelnotice.html
     
    The updated General Notice must be provided to ALL qualified beneficiaries (not just covered employees), who have not yet received an election notice and experienced a qualifying event from 9-1-2008 through 3-31-2010.
     
    Different groups need different information:
    -Individuals currently receiving assistance need to know they now have up to 15 months (2010 DOD Act).
    -Individuals in transition need to know they can reinstate or obtain refund / credit
     
    TIP:
    It is recommended that the notice be mailed First Class mail or with a Certificate of Mailing available at any post office.
     
    It is not recommended that Certified Mail be used as delivery is delayed until the recipient signs and receives the envelope. Additionally this type of mailing can only be addressed to one individual and when dependents are covered the notice must be addressed to all Qualified Beneficiaries eligible to elect COBRA.
    To reduce the risk of COBRA liability, employers are well-advised to adopt and consistently administer policies regarding the status of employees who are unable to return to work after injury or illness. Such policies should address, among other things, when active health coverage terminates, when COBRA will be offered, whether the employee will receive some period of employer-paid coverage, and how that coverage will interact with COBRA.


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  8. Please define Involuntary Termination (IT) in the context of ARRA (The American Recovery & Reinvestment Act of 2009)


    From IRS Notice 2009-27

    • A severance due to the independent exercise of the authority of the employer, other than the employee’s explicit request
      May include the employer’s failure to renew a contract if the employee was willing and able to execute a new contract.
    • A reduction of hours in itself is not an IT, HOWEVER, the employee’s resulting termination may be IT.
    • Retirement is not an IT. However, if absent retirement, the employer would have terminated the employee, it is IT.
    • Clarified 6-4-2009 that an Involuntary Termination includes when a member of a military Reserve unit or the National Guard is called to active duty, regardless of whether the civilian employer otherwise treats the employee's absence as a termination of employment or a leave of absence.
    • Clarified 6-4-2009 that if an employer determines that an employee's termination was involuntary for purposes of claiming the payroll tax credit, the IRS will not challenge that determination so long as it is consistent with a "reasonable interpretation of the applicable statutory provisions and IRS guidance." The IRS Q&A adds that the employer is required to maintain supporting documentation of its determination that the employee's termination of employment was involuntary, which should include an attestation by the employer of the employee's involuntary termination.


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  9. Who is a Qualified Beneficiary (QB) and how long does a Qualified Beneficiary have to elect coverage ?


    A QB is an individual who was covered by a group health plan on the day before a Qualifying Event. In certain cases involving bankruptcy of the employer, a retired employee, their spouse and children may be qualified beneficiaries. In addition, any child born to or placed for adoption with a covered employee during a period of continuation coverage is automatically considered a qualified beneficiary. Agents, independent contractors, and directors who participate in the group health plan may also be qualifed beneficiaries.
    QBs have the same rights as active at work individuals. They must be offered any new plans the employer may offer and they may change plans at open enrollment. Under Federal COBRA, each person covered the day of the "event" have equal rights on their own.
    They have 60 days from the loss of coverage or from the date the notice is provided by the employer to elect.
    However, under ARRA, The American Recovery & Reinvestment Act of 2009, Assistance Eligible Individuals may apply for the subsidy anytime while covered.

    A new provision provided by ARRA for persons eligible for Federal COBRA is that if the plan sponsor / employer permits, the Assistance Eligible Individual may change to a plan of lesser premium other than a standalone dental, vision, and HRAs. This change can be made within 90 days of election of COBRA coverage.


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  10. Are employees that the employer does not consider full time counted to determine the 20 or more employees ?


    Yes !   The employer determines what full time hours are (up to 40 hours for Federal COBRA purposes) and those working under full time count as fractions. 
    Example: A company has 10 full time 40 hour per week employees and 30 working a total number of 400 hours.
    40 full time divided into 400 part time hours equals 10. The 10 full time plus 10 equivalent to full time equals 20 on the payroll. If there have been 20 for at least 50% of the typical business days of the preceding year, the group must comply with COBRA.


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  11. Which employers are exempt ?


    Plans sponsored by the Federal Government, church related organizations,  those that have less than 20 employees or have 20 or more for less than 50% of the preceding year.


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  12. Who pays the premium and to whom ?


    Persons involuntarily terminated since September 1, 2008 are Assistance Eligible Individuals. They will pay 35% of the COBRA premium.  Employers subject to Federal COBRA pay 65% of the COBRA premium and are reimbursed via payroll taxes on Form 941. Under state continuation plans, the carrier pays the 65% and is reimbursed via payroll taxes.
    See here for information on changes to COBRA via The American Recovery & Reinvestment Act of 2009 http://www.savoyassociates.com/newsdetail.aspx?id=2019
     
    Continuees pay the full premium being charged by the carrier, 100% of the employee and employer contribution and the premium is paid to the employer.
    The employer may charge a 2% administrative fee.
    For those who extend coverage from 18 to 29 months due to Medicare Disability, the employer may charge 150% of the total premium.


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  13. What is recommended to an employer who receives a COBRA premium check that bounces or is rejected for insufficient funds ?


    A Qualified Beneficiary must pay the entire COBRA premium on a timely basis to maintain coverage.
    If the premium is paid timely and the amount is not significantly less than the full COBRA premium, the plan must either: (1) accept the payment as payment in full; or (2) notify the individual that an additional amount is owed and provide an additional reasonable period to pay the amount owed even if allowed after the grace period. If a check bounces the amount is not significantly less but in fact zero and as such additional time need not be allowed. COBRA election forms and notices should clearly indicate that coverage will be terminated due to nonpayment.
    An "insignificant amount" is defined as less than $50 or 10% of the total premium.


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  14. Can the member(s) remain on COBRA even if they are eligible for other group coverage ?


    Yes.  COBRA coverage terminates when they become enrolled in other group coverage.
    However, under ARRA, The American Recovery & Reinvestment Act of 2009, Assistance Eligible Individuals are no longer eligible for a subsidy once they become eligible for another group health plan or Medicare.
    See here for information on changes to COBRA via The American Recovery & Reinvestment Act of 2009 http://www.savoyassociates.com/newsdetail.aspx?id=2019


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  15. Who is entitled to benefits ?


    Persons covered the day of the Qualifying Event are called Qualified Beneficiaries. Each is entitled to continue independently. This means that if the employee does elect continuation, that the spouse and or dependent children may elect independently without the employee.
    Union members who are covered by a collective bargaining agreement that provides for a medical plan also may be entitled to continued coverage.
    Note: Adult Children covered under Chapter 375 in N.J. are not eligible for continuation unless the employee has a qualifying event and also elects continuation coverage.
    Also, under ARRA, The American Recovery & Reinvestment Act of 2009, employees who were involuntarily terminated since Sepember 1, 2008 and their families may continue with subsidized premium.
    AEIs must be QBs, hence spouses or children added after the Qualifying Event are not eligible for the subsidy.
    Domestic Partners, Civil Union Partners and NJ Dependents to 31 are not eligible for the subsidy under ARRA.


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  16. Are Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs) subject to COBRA ?


    HRAs are considered a health plan and as such are subject to COBRA. HSAs are savings accounts and are not a health plan subject to COBRA.
    An Assistance Eligible Employee may only elect the HRA is s/he also elects the group health plan.
    One recommendation of COBRA rates for HRA:
    1. If the group has not had 1 year of usage they would use the 75% rule.  This states that the employers can charge 75% of the total HRA funding, plus 2% to cover administrative costs.  For example, if the HRA fund is $1000, the employer can charge $750/12 = $62.50 x 2%= $63.75 as premium for each month. 
    2. If the group has had 1+ year of usage, they would use the dollar amount from the previous year.  For example if they had a 45% usage rate the previous year the premium would be as follows.  If the HRA fund is $1000 the employer can charge $450/12=$37.50x 2%= $38.25 as the premium for each month. 
    A few things to keep in mind:
    • The full HRA funding must be available to the COBRA continuee just as it is for active employees.
    This Q&A was posted by the IRS June 4,2009:
    Q: If an assistance eligible individual has the option of paying COBRA premiums on a pretax basis under an HRA, can the individual’s 35 percent share of the premium be paid from the HRA?
    A. COBRA premiums paid on a pretax basis from an HRA are treated as paid by the employer and are not taken into account in determining whether an individual has paid his or her 35 percent share of the COBRA premiums.
    See Notice 2009-27, Q&A-22, Example 2. Therefore, the individual is not treated as paying the 35 percent and the subsidy does not apply. (06/04/09)
     


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  17. Are Domestic Partners, Civil Union Partners, and NJs Dependents to 31 considered  eligible for COBRA continuation as spouses/dependents ?


    Under COBRA, a Qualified Beneficiary is an employee, spouse or dependent child (as defined in the insurance contract).
    Under the Federal Defense of Marriage Act of 1996, the word "marriage" only refers to a legal union between one man and one woman, and the word "spouse" only refers to a person of the opposite sex who is a husband or wife. Based on the federal law definition, Domestic Partners and Civil Union Partners do not qualify as spouses for COBRA purposes.
    Dependents to 31 are not dependents as defined by COBRA.
    An employer may choose to provide COBRA-like rights to Domestic Partners. However, this would involve providing clear eligibility criteria and preparing special plan documents and COBRA-like notices as well as the agreement of the isurance carrier. Therefore, legal assistance should be solicited.
    Note: Although the NJ Small Group contract defines Domestic Partners as spouses and therefore eligible for COBRA, the federal law does not. 


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  18. Am I eligible for COBRA if my company closed or went bankrupt and there is no health plan?


    If there is no longer a health plan, there is no COBRA coverage available.  If, however, there is another plan offered by the company, the member may be covered under that plan.  Union members who are covered by a collective bargaining agreement that provides for a medical plan also may be entitled to continued coverage.


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  19. What is a Qualifying Event ?


    For employees:
    -termination of employment for other than gross misconduct or -reduction of work hours whereby the person loses eligibility for coverage
    permitting the employee and any covered dependents to remain on the group plan for 18 months.
    Under ARRA, The American Recovery & Reinvestment Act of 2009, employees who were involuntarily terminated since September 1, 2008 are eligible to continue on a prospective basis and pay 35% of the COBRA premium. See here for information on changes to COBRA via The American Recovery & Reinvestment Act of 2009 http://www.savoyassociates.com/newsdetail.aspx?id=2019

    For dependents:
    - death of the employee,
    - divorce or legal separation from the employee,
    - loss of dependent child status under the plan rules e.g no longer eligible due to age, marriage, or loss of full time student status and
    -an employee's termination off the group health plan due to enrollment onto Medicare
    permits a 36 month continuation on the group plan.
    If an employer terminates employee and family coverage when an employee becomes enrolled in Medicare the spouse and dependents who lose group coverage are entitled to 36 months of coverage. The 36 month clock begins on the date of the employee's Medicare entitlement, not the date of the qualifying event.
     
    To reduce the risk of COBRA liability, employers are well-advised to adopt and consistently administer policies regarding the status of employees who are unable to return to work after injury or illness. Such policies should address, among other things, when active health coverage terminates, when COBRA will be offered, whether the employee will receive some period of employer-paid coverage, and how that coverage will interact with COBRA.
    Note: COBRA is not available to an Adult Child covered under Chapter 375 in N.J. unless the employee/parent has a qualifying event and elects continuation coverage.


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  20. May a company that is no longer in business offer COBRA ?


    If there is no longer a health plan, there is no COBRA coverage available.  If, however, there is another plan offered by the company, you may be covered under that plan.  Union members who are covered by a collective bargaining agreement that provides for a medical plan also may be entitled to continued coverage.


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  21. What are the maximum durations of continuation of coverage ?


    When loss of group health coverage is due to termination of employment (for other than gross misconduct) or a reduction in work hours, Qualified Beneficiaries may continue for up to 18 months.
    Note that NY legislation extends the 18 months to 36 months for NY insureds in a fully insured grop plan.
     
    Anyone covered the day of the employee termination is a Qualified Beneficiary.
    Under ARRA, The American Recovery & Reinvestment Act of 2009, Assistance Eligible Individuals are eligible for a premium subsidy for 9 months (this was extended to 15 months with the 2010 Defense Appropriations Act signed December 19, 2009). The subsidy ends when the individual 1- becomes eligible for any other group health coverage, 2- becomes eligible for Medicare, or 3- has reached 18 months from the original termination date. Each termination event would qualify the AEI for a 9 month (now 15 month) subsidy. Under the new Act the termination must occur prior to February 28, 2010 but the subsidy will still be available if the coverage ends after that date before Jan 1, 2010. 
    See here for updated information under the 2010 Defense Act http://www.savoyassociates.com/NewsDetailPremium.aspx?id=2787
    A member who is deemed Medicare disabled retroactively to a date within the first 60 days of being on COBRA may extend their COBRA to 29 months.
     
    Dependent Qualifying Events allows continuation for 36 months. Note this does not apply to Adult Children who are no longer eligible.
    Special Rule for Employee's Medicare Entitlement Closely Followed by Qualifying Event of Termination or Reduction of Hours. If a covered employee becomes entitled to Medicare within the 18-month period before he or she experiences the qualifying event of termination of employment or reduction of hours, the employee's covered spouse and dependent children are entitled to COBRA coverage for a maximum period of 36 months, measured not from the date of the termination of employment or reduction in hours but from the employee's Medicare entitlement. (The covered employee remains entitled to a normal maximum period that ends).
    Note: COBRA is not available to an Adult Child covered under Chapter 375 in N.J. unless the employee/parent has a qualifying event and elects continuation coverage.
     
    Reservists and their covered family members may elect continuation coverage for 24 months.


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  22. Do Reservists have expanded continuation benefits ?


    Yes. The Veteran's Benefits Improvement Act of 2004 which became effective 12/10/2004 allows Reservists and their families to continue their employer sponsored health care coverage up to 24 months. The 24 month period is measured from the first day the Reservist begins active duty. Employers may charge Reservists whose active duty is over 31 days up to 102% of the full cost of benefits. This means that during the first 31 days of active duty, the employer contribution remains the same as when the employee was active at work.


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  23. May a person on COBRA add a dependent ?


    COBRA Continuees that are Qualified Beneficiaries have the same rights as Active at Work employees.  If the employer allows dependent coverage, the COBRA continuee may add a spouse or child.
    Note: An employee who has a qualifying event and is covering their Adult Child under Chapter 375 in N.J. and elects continuation may also continue the overage dependent for 18 months.


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  24. Can someone eligible for Medicare elect COBRA ?


    Yes.  They must be offered COBRA
    continuation coverage. However, keep in mind that regardless of the size of the group, once the employee is no longer active at work, Medicare becomes primary. As such, the employee should sign up for Medicare Parts A & B before the COBRA event.
    Under ARRA, The American Recovery & Reinvestment Act of 2009, persons eligible for Medicare are not eligible for the subsidy.


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  25. Must a new plan offering be offered to a COBRA continuee ?


    Yes.  Qualified Beneficiaries have the same rights as those who are Active at Work.


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  26. What if the continuee moves outside the service area of the plan ?


    If the employer already has a plan in place that will accommodate the member, s/he will be able to move to the other plan immediately without waiting until open enrollment.
    If there is no other plan in place, the employer is not obligated to create a plan solely for the continuee.


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  27. Is there a special COBRA law in New York for groups that do not qualify for Federal COBRA ?


    Yes. NY COBRA generally applies to fully insured groups that do not qualify for Federal COBRA e.g. groups with less than 20 on payroll. Churches are eligible for NY COBRA (they are NOT for Federal COBRA).  The continuation timeframes, election period, and costs are the same as Federal COBRA.
    However, the qualifying events are 1) termination of employment (for any reason) or 2) a loss of coverage due to a class of employee being eliminated for health coverage eligibility. Note that reduction of hours is NOT a qualifying event.  Persons enrolled or eligible for Medicare or any other group coverage may not enroll in NY COBRA.
    See our suggested NY COBRA employer notice in our forms section.
     
    Continuation of dental coverage is not included.
    For New York COBRA, go to http://www.ins.state.ny.us/faqs/faqs_cobra.htm
     
    For information on how NY COBRA works under The American Recovery & Reinvestment Act of 2009, see
    http://www.ins.state.ny.us/press/2009/p0903201.pdf
    Below is from an FAQ from http://www.ins.state.ny.us/faqs/faqs_cobra.htm February 2008.
     
    What type of notice does an employer have to give to employees who are leaving employment concerning State continuation rights for group accident and health insurance?

    Ans: Very often we receive calls form employers who are subject to state, rather than federal continuation requirements concerning what they must do when employees leave employment. Part of the answer is to be found in the Labor Law (Sections 195 and 217) but part is also to be found in Sections 3221 and 4305 of the Insurance Law.
    Section 195 provides that departing employees must receive notice from their employers of various items available to them including the right to continue group accident and health insurance coverage under the group plan. The law requires that the notice be provided within 5 working days of termination of employment. There is no precise format for the notice. The notice must identify the exact date of cancellation of employee benefits.
    For purposes of continuation, there are three elements that a notice should contain: the employee has the right to elect to continue on the group plan; the employee has 60 days from the later of receipt of the notice or termination of employment to decide; and, if the employee chooses to continue, he/she must notify the employer in writing and enclose the appropriate premium amount (this amount is the monthly cost of the insurance to which the employer may add 2% for administrative expenses). Future premiums will be due monthly in advance for up to the length of times indicated in the statute. For details about this item the employer may consult their group insurance policy.
     
    For information on how NY COBRA is working under The American Recovery & Reinvestment Act of 2009, see here http://www.ny.gov/governor/press/press_0311091.html
    NY is following Federal COBRA regarding the lesser plan option being an employer choice.
    The NY DOI is creating a form for carriers for NY miniCOBRA employers.


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  28. What are the penalties applicable for non-compliance with ARRA, The COBRA Premium Assistance Provisions of Title III ?


    DOL: $110 / day for failure of employer to send notices.
    IRS:$100 /day excise taxes.
    IRS: 110% of subsidy to AEIs who do not report to the former employer when they are no longer eligible for the subsidy i.e. becoming eligible for any other group plan or Medicare.
     


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  29. Where can I obtain further information?


    For inquiries regarding Federal COBRA check the Department of Labor website: www.dol.gov .
    Regarding the extension signed April 15, 2010 for involuntary terminations through May 31, 2010.
    Statement of Assistant Secretary Phyllis C. Borzi on the Extension of COBRA Subsidy Eligibility is available at http://www.dol.gov/ebsa/newsroom/2010/ebsa041610.html
    COBRA Premium Reduction Fact Sheet available at http://www.dol.gov/ebsa/newsroom/fsCOBRApremiumreduction.html
    Temporary Extension Act (terms through March 31, 2010): http://www.dol.gov/ebsa/newsroom/fsCOBRApremiumreduction.html 
    Rules under the 2010 Defense Act DOL (terminations through Feb 28, 2010): http://www.dol.gov/ebsa/newsroom/2009/ebsa122109.html
    Employer Reporting and Documentation Information
    ARRA-related questions may be directed to the Centers for Medicare & Medicaid Services (CMS) via email to NewCobraRights@cms.hhs.gov.
    The application to request that CMS review denials of premium assistance is now available for download in pdf format from www.continuationcoverage.net.
    Please redirect all other questions to: continuationcoverage@maximus.com or call toll-free at (866) 400-6689. Staff members are available from 8 a.m. until 8 p.m. EST.
    For expedited Appeal Rights, Procedures and Form.
    The application to request that CMS review denials of premium assistance is now available for download in pdf format from http://www.dol.gov/ebsa/COBRA/main.html
     
    For information on how NY COBRA works under The American Recovery & Reinvestment Act of 2009, see
    DOL Tollfree Hotline: 866-444-3272.
    You may also email Joan Fusco, Director, Research & Education at joanfusco@savoyassociates.com. Her cellular number is 848-391-3700.


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