Health Benefits Under the COBRA
Paying for COBRA Coverage continued...
The initial premium payment
must be made within 45 days after the date of the COBRA election by the
qualified beneficiary. Payment generally must cover the period of coverage from
the date of COBRA election retroactive to the date of the loss of coverage due
to the qualifying event. Premiums for successive periods of coverage are due on
the date stated in the plan with a minimum 30-day grace period for
The due date may not be
prior to the first day of the period of coverage. For example, the due date for
the month of January could not be prior to January 1 and coverage for January
could not be cancelled if payment is made by January 31.
Premiums for the rest of
the COBRA period must be made within 30 days after the due date for each such
premium or such longer period as provided by the plan. The plan, however, is
not obligated to send monthly premium notices.
COBRA beneficiaries remain
subject to the rules of the plan and therefore must satisfy all costs related
to deductibles, catastrophic and other benefit limits.
Health plan rules must
explain how to obtain benefits and must include written procedures for
processing claims. Claims procedures are to be included in the SPD
You should submit a written
claim for benefits to whomever is designated to operate the health plan
(employer, plan administrator, etc.). If the claim is denied, notice of denial
must be in writing and furnished generally within 90 days after the claim is
filed. The notice should state the reasons for the denial, any additional
information needed to support the claim and procedures for appealing the
You have 60 days to appeal
a denial and must receive a decision on the appeal within 60 days after that
unless the plan:
- provides for a special hearing,
- the decision must be made by a group which
meets only on a periodic basis.
Contact the plan
administrator for more information on filing a claim for benefits. Complete
plan rules are available from employers or benefits offices. There can be
charges up to 25 cents a page for copies of plan rules.
Coordination with Other Benefits
The Family and Medical
Leave Act (FMLA), effective August 5, 1993, requires an employer to maintain
coverage under any "group health plan" for an employee on FMLA leave
under the same conditions coverage would have been provided if the employee had
continued working. Coverage provided under the FMLA is not COBRA
coverage, and FMLA leave is not a qualifying event under COBRA. A COBRA
qualifying event may occur, however, when an employer's obligation to maintain
health benefits under FMLA ceases, such as when an employee notifies an
employer of his or her intent not to return to work.
Further information on FMLA
is available from the nearest office of the Wage and Hour Division, listed in
most telephone directories under U.S. Government, Department of Labor,
Employment Standards Administration.