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Employee Benefits Compliance Q&A: COBRA Length of Entitlement

Jan 14, 2020 Decorative image compliance Q and A

Each month in this series, we answer frequently asked compliance questions. Are you wondering whether your organization is compliant? Contact your Hylant representative or local Hylant office for a compliance checkup.

Q: How long are qualified beneficiaries entitled to COBRA?

A: The length of time that a qualified beneficiary is entitled to COBRA varies based on the situation.

Where a loss of coverage is a result of an employee’s termination of employment (other than by reason of gross misconduct) or reduction in hours, qualified beneficiaries are entitled to continue coverage for a maximum of 18 months.

Where a loss of coverage is a result of any of the following, qualified beneficiaries are entitled to continue coverage for a maximum of 36 months:

  • Death of a covered employee
  • Divorce or legal separation of a covered employee from his or her spouse
  • A covered employee becoming entitled to Medicare benefits
  • A dependent child ceasing to be a dependent child under the terms of the health plan

Where a loss of coverage is a result of an employee’s termination of employment (other than by reason of gross misconduct) or reduction in hours and a qualified beneficiary is determined by the Social Security Administration to be disabled (for Social Security disability purposes) before, at or within 60 days of the date of the qualifying event, all qualified beneficiaries within that family are entitled to an 11-month extension of the maximum period of continuation coverage (for a maximum period of 29 months). To benefit from this extension, any qualified beneficiary within the family must notify the plan administrator as required by the reasonable procedures established by the plan administrator. Where a qualified beneficiary was determined disabled by the Social Security Administration prior to the qualifying event, the qualified beneficiary is considered to meet the statutory requirement of being disabled “within the first 60 days of COBRA coverage.”

For more compliance news and information, read our recent blog posts:

The above information does not constitute advice. Always contact your employee benefits broker or trusted adviser for insurance-related questions.

 

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