elaws - Health Benefits Advisor for Employers

Health Benefits Advisor for Employers

Plan Compliance Results

COBRA requires group health plans to offer continuation coverage to covered employees, former employees, spouses, former spouses, and dependent children when group health coverage would otherwise be lost due to certain specific events. Those events include the death of a covered employee, termination or reduction in the hours of a covered employee's employment for reasons other than gross misconduct, a covered employee's becoming entitled to Medicare, divorce or legal separation of a covered employee and spouse, and a child's loss of dependent status (and therefore eligibility for coverage) under the plan.

COBRA sets rules for how and when continuation coverage must be offered and provided, how employees and their families may elect continuation coverage, and what circumstances justify terminating continuation coverage.

Qualifying Events - Plan Procedures for Employees and Qualified Beneficiaries To Provide Notice

Types of Benefits Offered Under COBRA

Conversion Option

Summary Plan Description
Because you indicated that your group health plan's summary plan description (SPD) does not include a description of the rights and obligations of participants and beneficiaries with respect to COBRA coverage, including, among other things, information concerning qualifying events and qualified beneficiaries, premiums, notice and election requirements and procedures, and duration of coverage, does not appear to comply with this SPD content requirement.

General Notice
Because you indicated that your plan administrator does not provide a proper general notice describing COBRA rights to each covered employee and each covered spouse of a covered employee within the required timeframes, does not appear to comply with this provision of COBRA.

Qualifying Events - When an Employer Must Provide Notice
Because you indicated that you, the employer, do not notify your plan administrator about certain qualifying events within the required time limit, does not appear to comply with this provision of COBRA.

Notice of Unavailability of Continuation Coverage
Because you indicated that when your plan administrator denies a request from an individual for COBRA coverage relating to a qualifying event, second qualifying event, or determination of disability by the Social Security Administration, the plan does not provide that individual with an explanatory notice of unavailability of COBRA coverage within 14 days after the request is received, does not appear to comply with this COBRA notice requirement.

Election Notice
Because you indicated that your plan administrator does not provide qualified beneficiaries with a proper election notice within the required timeframes, does not appear to comply with this provision of COBRA.

Rights of Qualified Beneficiaries in Electing COBRA Coverage
Because you indicated that your group health plan does not provide each qualified beneficiary with at least 60 days to elect COBRA coverage, and does not permit each qualified beneficiary to revoke his or her waiver of COBRA coverage during that election period, does not appear to comply with these provisions of COBRA.

Maximum Duration of COBRA Coverage
Because you indicated that your group health plan does not provide at least the maximum required period of COBRA coverage for each type of qualifying event, does not appear to comply with this provision of COBRA.

Extension of COBRA Coverage
Because you indicated that your group health plan does not have reasonable procedures for providing notice of the extension of an 18-month period of COBRA coverage due to a second qualifying event or disability determination by the Social Security Administration, does not appear to comply with these provisions of COBRA.

Who Pays for COBRA Coverage
Because you indicated that your group health plan charges qualified beneficiaries for COBRA coverage more than 102 percent of the cost to the plan for similarly situated individuals covered under the plan who are not receiving COBRA coverage, does not appear to comply with this provision of COBRA.

Notice of Early Termination of Continuation Coverage
Because you indicated that when your group health plan terminates the COBRA coverage of one or more qualified beneficiaries early for certain reasons, the plan administrator does not provide each of those qualified beneficiaries with a notice of early termination as soon as practicable after the decision to terminate is made, does not appear to comply with this COBRA notice requirement.

Note: If you would like to review the information provided within this Advisor, you may select that issue above and it will take you back to that section in the Health Benefits Advisor where you can reread the description and answer the question again. This Advisor provides general guidance and users are encouraged to review their specific health plan or health plan options in conjunction with the general information provided. In addition, the Advisor does not address health benefits offered through Federal, state, or local government plans or church plans.

Coordination With Other Federal Benefit Laws
You may need to consider other Federal benefit laws when applying COBRA rights and responsibilities. For more information on the coordination of these other laws, please see:

The following health laws under Title I of ERISA may apply to your employer sponsored group health plan. You may select the following laws to determine compliance.

For more information on COBRA visit:

For more information on Compliance Assistance visit:

The Affordable Care Act (ACA) provides additional health protections. This website does not reflect the passage of the ACA. For an overview of the Affordable Care Act, please visit the ACA Summary. For regulations, guidance and additional information, please visit the Department of Labor's ACA webpage.

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