U.S. Department of Labor
Health Benefits Advisor for Employers
Consolidated Omnibus Budget Reconciliation Act (COBRA)
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.
Based on your responses, your plan appears to be in compliance with the following COBRA provisions:
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
Based on your responses, your plan does NOT appear to be in compliance with the following COBRA provisions:
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.
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.
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 Family and Medical Leave Act (FMLA)
- Health Insurance Portability and Accountability Act (HIPAA)
- The Trade Act of 2002
Determine compliance with other applicable ERISA Laws:
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.
- Health Insurance Portability and Accountability Act (HIPAA)
- Mental Health Parity Act (MHPA) and Mental Health Parity and Addiction Equity Act (MHPAEA)
- Newborns' and Mothers' Health Protection Act (Newborns' Act)
- Women's Health and Cancer Rights Act (WHCRA)
- Genetic Information Nondiscrimination Act (GINA)
- Michelle's Law
For more information on COBRA visit:
- An Employer's Guide to Group Health Continuation Coverage Under COBRA
- Reporting and Disclosure Guide For Employee Benefit Plans
- Fact Sheet
- Frequently Asked Questions About COBRA
- COBRA General and Election Model Notices (English and Spanish)
- DOL Statute
- DOL Regulations
- IRS Regulations
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.
