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Period of Coverage
Plan Coverage
Qualified Beneficiaries
Qualifying Events
There are three
elements to qualifying for COBRA benefits. COBRA
establishes specific criteria for plans,
qualified beneficiaries, and qualifying events.
These elements will determine the Period of
Coverage.
Period of Coverage
|
Qualifying Events |
Beneficiary |
Coverage |
|
Employment termination or
reduced hours |
Employee, spouse, dependent
child |
18
months* |
|
Employee enrolled in Medicare |
Spouse/Dependent child |
36
months |
|
Divorce or legal separation |
Spouse/Dependent child |
36
months |
|
Death of covered employee |
Spouse/Dependent child |
36
months |
|
Loss of "dependent child" status |
Dependent child |
36
months |
*In the
case of certain individuals who are
disabled within the meaning of the
Social Security Act, special rules may
apply to extend coverage an additional
11 months (from 18 to 29 months) to that
individual and other individuals who are
qualified beneficiaries with respect to
the same qualifying event. See
Notice Procedures,
Duration of Coverage and
Paying for COBRA Coverage for more
information regarding the
disability-based 11-month extension.
Also, the 18-month (or 29-month) period
of coverage may be extended to 36 months
for a spouse or dependent child who is a
qualified beneficiary and experiences a
second qualifying event during the
initial 18-month (or 29-month) period of
continuation coverage. See
Duration of Coverage for more
information about second qualifying
events. |
Group health
plans for employers with 20 or more employees on
more than 50 percent of their typical business
days in the previous calendar year are subject
to COBRA. Both full- and part-time employees are
counted to determine whether a plan is subject
to COBRA. Each part-time employee counts as a
fraction of an employee, with the fraction equal
to the number of hours that the part-time
employee worked divided by the hours an employee
must work to be considered full-time.
A qualified
beneficiary generally is an individual covered
by a group health plan on the day before a
qualifying event and is either an employee, the
employee's spouse, or an employee's dependent
child. In certain cases, a retired employee, the
retired employee's spouse, and the retired
employee's dependent children may be qualified
beneficiaries. In addition, any child born to or
placed for adoption with a covered employee
during the period of COBRA coverage is
considered a qualified beneficiary. Also,
agents, self-employed individuals, independent
contractors and their employees, directors,
political appointees and elected officials who
participate in the group health plan may be
qualified beneficiaries.
"Qualifying
events" are certain events that would cause an
individual to lose health coverage. The type of
qualifying event will determine who the
qualified beneficiaries are and the amount of
time that a plan must offer the health coverage
to them under COBRA. A plan, at its discretion,
may provide longer periods of continuation
coverage.
The qualifying
events for employees are:
- Voluntary
or involuntary termination of employment for
reasons other than "gross misconduct"
- Reduction
in the number of hours of employment
The qualifying
events for spouses are:
- Voluntary
or involuntary termination of the covered
employee's employment for any reason other
than "gross misconduct"
- Reduction
in the hours worked by the covered employee
- Covered
employee's becoming entitled to Medicare
- Divorce or
legal separation of the covered employee
- Death of
the covered employee
The qualifying
events for dependent children are the same as
for the spouse with one addition:
- Loss of
"dependent child" status under the plan's
rules
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