According to the Consolidated Omnibus Budget and Reconciliation Act (COBRA), employers who offer a group health plan for more than 20 employees must offer temporary continuous coverage to qualifying beneficiaries after qualifying events.

A qualified beneficiary generally is an individual covered by a group health plan on the day before a qualifying event who is either an employee, the employee’s spouse, or an employee’s dependent child.

A qualifying event is a circumstance that would cause the qualified beneficiary to lose their group plan. The type of event determines the length of coverage offered, but continuous plans range between 18 and 36 months. Here are some examples of qualifying events:

• The death of a covered employee
• A covered employee’s termination or reduction of hours
• The covered employee’s new entitlement to Medicare
• Divorce or legal separation from a covered employee
• A dependent child ceasing to be a dependent under the plan’s requirements

Employees must be offered health care, dental, vision, medical spending accounts, hearing, prescription, substance abuse, and mental health plans, but only if you offered those services under your group plan.

Generally, the qualified beneficiary pays the entire cost of the continuous coverage plus two percent to account for your administrative costs. Employees who take COBRA coverage for a disability can be charged 150% of their premiums for coverage after month 18.

Per regulations, employers are required to provide certain COBRA notices with specific information and timeframes, depending on the circumstances.  Failure to comply with these regulations can result in fines of $100 to $400 per day per qualifying beneficiary.

4 Notices Required by COBRA

General Notice

This document describes employees’ COBRA rights and the employer’s responsibilities. It must be given to each covered employee and each employee’s spouse within the first 90 days of coverage. It needs to have the following information:

• Name of plan and contact information of the plan’s COBRA administrator.
• A description of the coverage provided by the plan.
• Instructions for beneficiaries to notify the administrator of qualifying events or disabilities.
• An explanation of the importance of notifying the administrator about address changes.
• A statement that the notice does not fully describe COBRA or the plan, and that more information is available through the plan’s administrator.

Click here to see a sample General Notice.

Election Notice

This document explains the employee’s rights to continuation coverage and how to elect it. The administrator must send an election notice to each beneficiary who loses their coverage due to a qualifying event within 14 days.

• Name of plan and contact information of the plan’s COBRA administrator.
• Identification of the qualifying event and qualified beneficiaries.
• An explanation of the beneficiaries’ right to elect continuation coverage.
• The date coverage will terminate if continuation coverage is not elected.
• The process to officially elect the coverage.
• Outcomes if coverage is waived or not elected.
• How coverage might terminate early.
• Premium information, including amounts, grace periods, and schedules.
• The type and scope of coverage available and how it can be extended for disability or other qualifying events.
• An explanation of the importance of notifying the administrator about address changes.
• A statement that the notice does not fully describe COBRA or the plan, and that more information is available through the plan’s administrator.

Click here to see a sample Election Notice.

Unavailability of Continuation of Coverage Notice

Should an individual request continuous coverage, but the plan administrator determines that the individual is not entitled to coverage, the administrator must send a notice of unavailability. This simple document must be provided within 14 days of the original request and explain the reason for denial.

Click here to see a sample Unavailability of Continuation of Coverage Notice.

Termination of Coverage Notice

If an individual’s coverage is terminated early, the employer must provide a termination notice. This notice must include the following information:

• The date coverage will terminate.
• The reason coverage is being terminated.
• Any rights the qualified beneficiary has under the plan (or the law) to elect alternative coverage, such as the right to convert the plan to a private policy.

There is no timeframe to provide this notice, but regulations say it should be delivered as soon as the decision to terminate coverage is made.

Click here to see a sample Termination of Coverage Notice.

Providing proper COBRA documentation with the right content is an important part of staying compliant with the legislation, but you also need to document the method, timing, and last address of your deliveries. This is for your protection in case you are required to provide evidence that you upheld your obligations.

For more information about disclosure rules (such as the allowed methods for delivery and specific timing requirements), see CFR 2520.104b-1(B). For a detailed breakdown of your obligations and FAQ’s, visit the Department of Labor’s website.

Navigating the rules and requirements of COBRA can be confusing and overwhelming. If you have questions or concerns, Sinclair Risk is here to help – Give us a call!

Shannon Hudspeth
Human Resource Director
shudspeth@srfm.com