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Charming the COBRA: A Summary of the Rules Governing Your Health Coverage

Posted by David P. Martin | Aug 04, 2020 | 0 Comments

COBRA allows you to continue your health insurance coverage even if you no longer qualify for it (because of a change in employment or a relationship, for example). Just like you shouldn't attempt to charm a snake without knowing what you are doing, here are some basics about COBRA coverage.

They provide a framework for asking more informed questions and note some potential problems to watch out for.[1] If you lose your health insurance coverage, and you are denied (or not given) the right to continue it, you should contact a lawyer.

1. Your employer must have 20 employees or more on a typical business day during the prior calendar year in order for COBRA benefits to apply.

If less, no COBRA. But, courts do not like an employer who attempts to use 40 part-time people to circumvent that.

2. Something must happen which causes you to lose your health insurance coverage.

Examples are termination, decrease in hours, death, divorce, or legal separation. If you are no longer a dependent child, but you were previously covered, that too can be an example. These events causing loss of coverage are called qualifying events.

3. If you lose your coverage due to one of these qualifying events, you have a right to receive a notice about how you can continue your health insurance coverage.

The employer is supposed to notify the administrator of the plan within 30 days of the event. Sometimes the employer may be the administrator, which can shorten the time.

4. The notice is supposed to be sent within 14 days after the administrator is notified about the qualifying event.

So, if you lose your health insurance, notice should be sent to you by the 44th day after the qualifying event. (For multiemployer plans that can be longer, so you have to look at the plan for that.)

5. Notice to the covered employee serves as notice to all who live in the same house.

If you lose your health insurance due to a divorce and you had your coverage through your ex-spouse, your ex cannot play games and keep the notice from you. If you no longer reside with your ex or receive mail elsewhere, let the employer and plan administrator know your new address.

6. You have 60 days from the date of the notice to elect coverage.

Follow the instructions on the notice and send your premium and your forms so that they are received before that 60th day.

7. The health insurance has to provide the same coverage you had before.

So pre-existing conditions should be covered.

8. The continued coverage lasts for 18 months.

If a former employee is classified as disabled by the Social Security Administration and informs the administrator before that 18th month, coverage can be extended to 36 months.

9. Your coverage will stop if you do not make premium payments within 30 days of their due dates.

One day late and you lose it.

10. You may be entitled to convert the health insurance to your own health insurance benefit if the plan has that conversion option.

That means you can keep the coverage going forward without going through the employer. There is a 180-day time frame beginning about the one year mark after you started the coverage during which you are supposed to be allowed the option to convert your coverage if the plan allows for that.

So, there are some basics. Of course, the devil is in the details. There is much more to COBRA. You should consult an attorney experienced in handling ERISA and COBRA claims if you have a specific question, issue or problem. An experienced ERISA attorney can help you charm the COBRA.

[1] But this brief overview is no substitute for legal advice and doesn't attempt to cover every unique fact situation. Your situation may be different.

About the Author

David P. Martin

Senior & Managing Attorney


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