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 - When an Employer Must Provide Notice

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

Rights of Qualified Beneficiaries in Electing COBRA Coverage

Maximum Duration of COBRA Coverage

Types of Benefits Offered Under COBRA

Who Pays for COBRA Coverage

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.

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.

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.

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.

Conversion Option
Because you indicated that your group health plan contains a conversion option, and that option is not offered to each qualified beneficiary during the 180 days before COBRA coverage ends, does not appear to comply with this provision of COBRA.

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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