COBRA Participant Toolkit

Qualified Beneficiaries and Events

Qualified Beneficiaries
Federal law requires most group health plans to offer employees and their covered family members the opportunity to continue their health care coverage when there is a "qualifying event" that would result in a loss of coverage under an employer's plan.

"Group Health" plans are medical, dental, vision, the Health Care Flexible Spending Account, and some Employee Assistance Programs (EAP's)

Each family member who elects continuation coverage will have the same rights as Plan participants, including open enrollment and special enrollment rights.

Different qualifying events have different requirements for reporting them to your employer. They also vary in the maximum length of time for which COBRA applies.
Qualifying Events
Qualifying Events are events that occur that cause an employee and/or his/her dependents to lose company-sponsored group health coverage. When a qualifying event occurs, a covered plan member becomes a Qualified Beneficiary, and gains rights to continue coverage under COBRA. Under the following qualifying events, benefits may be continued for all Qualified Beneficiaries for a maximum period of 18 months:

- The employee's hours of employment are reduced to the point that the employee loses benefit eligibility
- The employee's employment ends for any reason other than gross misconduct

For covered spouses or dependent child(ren), there are additional qualifying events under which benefits may be continued for a maximum period of 36 months. It is your responsibility to notify the Plan Administrator of these occurrences within 30 days of the event:

- The employee dies
- The employee becomes entitled to Medicare benefits (Part A, Part B, or both);
- The employee and his/her spouse become legally separated from each other or divorced, which impacts benefits coverage for the spouse and/or child(ren);
- A child is no longer eligible for coverage as a dependent child (usually due to over-age status)
Second Qualifying Events
There are situations where a second qualifying event occurs. For example, an employee terminates employment and then subsequently divorces. In this situation, the maximum period of coverage for the employee remains 18 months, and the maximum period for the impacted dependent(s) remains 36 months. You must provide proper notice to the Plan administrator within the required timeframes in order to receive this extension.
Additional Time Extensions
Under very limited circumstances, there are times when COBRA may be extended. Many of these circumstances also impact the amount that is paid for COBRA. They are:

Disability: If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled, you and your entire family may be entitled to receive an extension on your COBRA of an additional 11 months, for a maximum total of 29 months of coverage. The premium payments are 150% of total active employees' premiums for the 11-month extension period.

Medicare Entitlement: The spouse or dependent may have additional COBRA timeframes if the employee becomes entitled to Medicare benefits (Part A, Part B, or both);

California COBRA Extension: California residents may be eligible to extend COBRA to a maximum of 36 months. The period from 19 through 36 months is charged at 110% of the total active employees' premiums.

Additional state-provided Extensions: Check with your plan administrator to see if additional extensions apply.