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    Health Care Reform:

    Health Insurance & Affordable Care Act

    Health Benefits Under the COBRA

    Qualifying Events

    "Qualifying events" are certain types of events that would cause, except for COBRA continuation coverage, an individual to lose health coverage. The type of qualifying event will determine who the qualified beneficiaries are and the required 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 types of 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 types of qualifying events for spouses are:

    • 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 types of qualifying events for dependent children are the same as for the spouse with one addition:

    • loss of "dependent child" status under the plan rules

    Periods of Coverage3

    Qualifying Events

    Beneficiary

    Coverage

    Termination

    Employee

    18 months4

    Reduced Hours

    Spouse

    Dependent Child

    Employee entitled to Medicare

    Spouse

    36 months

    Divorce or legal separation

    Dependent child

    Death of covered employee

    Loss of "dependent child" status

    Dependent child

    36 months

    3. The Omnibus Budget Reconciliation Act of 1986 contained amendments to the Internal Revenue Code and ERISA affecting retirees and family members who receive post-retirement health coverage from employers involved in bankruptcy proceedings begun on or after July 1, 1986. This article does not address that group.
    4.
    In the case of individuals who qualify for Social Security disability benefits, special rules apply to extend coverage an additional 11 months.

    Your Rights: Notice and Election Procedures

    COBRA outlines procedures for employees and family members to elect continuation coverage and for employers and plans to notify beneficiaries. The qualifying events contained in the law create rights and obligations for employers, plan administrators and qualified beneficiaries.

    Qualified beneficiaries have the right to elect to continue coverage that is identical to the coverage provided under the plan. Employers and plan administrators have an obligation to determine the specific rights of beneficiaries with respect to election, notification and type of coverage options.

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