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A Service of OnQue Technologies, Inc. |
| Determining COBRA Start
Dates: Exceptions to the General Rule |
October 9, 2003 Santa Rosa, CA |
At first glance, the rule looks
simple: The COBRA coverage period runs from the date of the qualifying event
that causes a loss of coverage under the group health plan. And this is true
regardless of whether the loss of coverage is an immediate loss, or one that is
delayed to a future date. But like most rules, this one has exceptions. This
COBRA tip will explore the specific situations that cause COBRA coverage to
begin on dates other than the qualifying event date.
Loss of coverage date
rule. As an alternate rule, ERISA permits you to begin COBRA coverage on
the date health plan coverage is actually lost, rather than on the qualifying
event date, but only if your Summary Plan Description or group health
plan document clearly sets out that:
- The
maximum COBRA coverage period will begin to run from the date plan coverage is
lost; and
- The
employer has 30 days from the date group health plan coverage is lost in which
to notify the plan administrator that a qualifying event has
occurred.
Most
group plans provide coverage through the end of the month, so the practical
effect of this rule is to provide more than 18 or 36 months of
coverage.
Example: If David had been fired on April
10, 2002, his group health plan coverage would likely be in effect through
April 30. Under the general rule, his 18-month COBRA coverage period would
begin on April 10, the date of his termination and the COBRA qualifying event.
However, if David's employer has implemented the loss of coverage date option,
it would have to offer him COBRA coverage beginning May 1, the loss of coverage
date. This would effectively extend David's period of health plan coverage 20
additional days.
Exceptions under the general rule. Even when
you follow the general rule of offering COBRA coverage as of the date of the
qualifying event, certain factors may exist that will cause a change in the
normal start date. These special circumstances are discussed
below.
- Newly
adopted and newly born dependents: A child who is born to, adopted by, or
placed for adoption with a covered employee while she is on COBRA coverage is a
qualified beneficiary who may elect COBRA coverage. However, COBRA regulations
provide that the COBRA start date for that child is the same as the employee's
start date, not the date of the birth or adoption, as is commonly thought. That
child will be entitled to COBRA only for the duration of the employee's maximum
COBRA coverage period.
Example: David is fired on April 10, 2002,
and elects COBRA coverage. On September 1, while still on COBRA, he adopts a
child and elects COBRA coverage for him. The child's COBRA start date is April
10, not September 1. Barring a second qualifying event, the child's coverage
will terminate at the same time David's coverage ends - 18 months from the
original qualifying event date.
- Dependents of Medicare recipients. If an
employee who is covered under the group health plan terminates employment or
suffers a reduction in hours within 18 months of being entitled to Medicare, he
must be offered 18 months of COBRA coverage, starting from the date of
termination. However, the spouse and dependent children of that employee will
be entitled to 36 months of COBRA coverage, beginning on the date of the
employee's entitlement to Medicare, not the date of the qualifying event.
Example: David became entitled to Medicare
on January 1, 2002 and remains covered under the plan. On July 1, he was fired.
David must be offered 18 months of COBRA coverage starting July 1, the date of
the qualifying event. His spouse will be offered 36 months of coverage.
However, her maximum COBRA coverage period will be measured from January 1, the
date on which David became entitled to Medicare, not from the qualifying event
date.
- FMLA
leave of absence. You are required by law to maintain group health plan
coverage for employees who take leaves of absence under the federal Family and
Medical Leave Act (FMLA). Therefore, the taking of FMLA leave cannot be a COBRA
qualifying event because no loss of coverage occurs. A COBRA qualifying event
does occur, however, for employees and their spouses and dependents who are
covered under the group plan on the day prior to the first day of FMLA leave,
if the employee fails to return to work at the end of the leave period. The
maximum COBRA coverage period begins on the last day of the FMLA leave.
Similarly, a COBRA qualifying event occurs if an employee on FMLA leave informs
you prior to the end of the leave period that she won't be returning to work.
In that case, the qualifying event is the date on which the employee notifies
you that she won't be returning. COBRA coverage begins on the date of that
notification, not at the end of the leave period.
- Non-FMLA leave of absence. A non-FMLA leave
is the same as a reduction in the employee's work hours, but it will be a COBRA
qualifying event only if the leave results in a loss of health coverage under
the group plan. The start of the maximum COBRA coverage period for an employee
who goes out on non-FMLA leave will depend upon how each employer treats leaves
of absence. Some will end group coverage at the start of the leave and so the
first day of the leave is the beginning of the COBRA coverage period. Others
may continue to carry the employee on the group plan during the entire period
of the leave or some portion of it. In such cases, if the employee does not
return to work, COBRA coverage begins on the day after plan coverage ends. Your
plan documents must clearly state your policy regarding leaves of absence and
loss of plan coverage so COBRA rights will be uniformly
applied.
- Waiver of COBRA coverage. Qualified
beneficiaries must elect COBRA coverage within 60 days from the date they lose
coverage under the plan as a result of a qualifying event, or the from the date
the election notice is provided, whichever is later. It is not necessary for a
beneficiary to decline or "waive" the offer of continuation coverage. In most
cases, persons who don't want COBRA coverage will just allow the 60-day
election period to expire. But sometimes a beneficiary affirmatively waives
coverage. Even so, an election may be made after a waiver so long as it is made
within the original 60-day election period. (Under COBRA rules, a revocation of
a waiver is considered an election of continuation coverage.) But when a waiver
of COBRA is revoked, the COBRA start date is not retroactive to the date of the
qualifying event; coverage is restored only to the date of revocation, which
results in a lapse of coverage.
Example: David is terminated on September 1,
2002; loses coverage under the plan on September 30; receives the COBRA
election notice on September 15; and notifies his employer in writing on
October 1 that he does not want continuation coverage. However, on October 29,
he changes his mind and properly elects COBRA. His coverage begins on October
29, rather than on September 30, the date on which he lost plan
coverage.
- Employer's bankruptcy. When an employer
files a petition under Chapter 11 of the federal bankruptcy code, special COBRA
rules apply to retirees who lose coverage under the plan as a result of the
bankruptcy. The filing of the bankruptcy petition is a COBRA qualifying event.
A retiree is entitled to coverage for life, and as long as the retiree is
alive, his covered spouse and covered dependent children are entitled to
coverage. But when the retiree dies, the surviving spouse or dependent children
are entitled to only 36 months of coverage beginning from the date of the
retiree's death, not the date of the bankruptcy
filing.
- TAA
special election. The 2002 Trade Act (TAA) amended COBRA regulations for
certain employees who lost their jobs as a direct result of foreign
competition. If TAA-certified employees failed to elect COBRA coverage during
their first 60-day election period, they are entitled to a second election
period. During this special election period, the employee may elect COBRA
coverage for himself and for his spouse and dependent children. (Spouses and
dependents cannot elect for themselves during the TAA second election period).
If elected, continuation coverage begins on the first day of the special TAA
election period, not on the earlier loss of coverage
date.
- Anticipation of Divorce. Divorce or legal
separation is a COBRA qualifying event that results in 36 months of COBRA
coverage for the spouse of an employee if she loses coverage as a result of the
divorce. The COBRA start date is the date of the divorce decree, which is the
qualifying event. But, if an employee drops coverage for a spouse in
anticipation of a divorce, then the spouse's COBRA coverage begins on the date
of the divorce, not on the earlier loss of coverage date.
Conclusion: Under the newly proposed COBRA
regulations, election notices must contain a description of the coverage
available for each qualified beneficiary under the plan and the date on which
coverage, if elected, would commence. It is not sufficient to merely state the
general rule that coverage begins on the date of the qualifying event. Election
notices must be tailored to specific situations and beneficiaries in order to
accurately state the COBRA commencement date. |
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| Related COBRA
Tips |
| New COBRA Notice Rules
Proposed By Labor Department |
| FMLA and COBRA: How Do They
Interact? |
| The Trade Act of 2002:
How will it affect COBRA administration? |
| Description of COBRA rights must
be included in SPD |
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This information is provided by
OnQue Technologies, Inc. for educational purposes only and does not constitute
legal advice. If legal advice or other professional assistance is required, the
services of a competent professional should be sought. |
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