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After Coverage Ends - COBRA

Questions and Answers About
When Your Coverage Terminates – COBRA
Prepared By
The Employee Benefit Service Center

Q     After my benefit coverage terminates, is there other coverage available?
A     You may be entitled to COBRA coverage, a federal program that extends your coverage on the plan for certain time periods.

Q     How does COBRA extend my coverage?
A      Each qualified beneficiary who loses coverage as a result of the qualifying event, must be offered an opportunity to elect to receive the group health plan coverage that was provided on the day before the qualifying event.

Q     Who is a qualified beneficiary?
A     Any individual who, on the day before the qualifying event, is covered under a group health plan by virtue of being on that day either a covered employee, the spouse of a covered employee, or the dependent child of a covered employee. Each one of the above types of individuals is a qualified beneficiary, independent of the others, and each qualified beneficiary has an independent right to COBRA coverage. In general, an individual who is not covered under a plan on the day before the qualifying event cannot be a qualified beneficiary with respect to that qualifying event. The exception is for children born or placed for adoption with a covered person during the period of COBRA continuation coverage. They are qualified beneficiaries.

    I am a qualified beneficiary because I had coverage under my employer’s plan and lost coverage due to a reduction in my hours worked. My COBRA coverage started three months ago and I am getting married and want to add my new spouse to my COBRA coverage. Can I do this?
A     Yes, your new spouse can be covered under your COBRA coverage upon your marriage. Your spouse will not be considered a qualified beneficiary (because the spouse was not on the plan at the time of the qualifying event) and if you die, your spouse will not have COBRA continuation rights. If you have a newborn or adopt a child during your COBRA coverage period, they can also be added to the coverage immediately, after enrollment and they would be a qualified beneficiary. 

Q     I am a qualified beneficiary because I had coverage under my employer’s plan and lost coverage due to a reduction in my hours worked. My COBRA coverage started three months ago, but even though my wife was covered on the plan at the time of the qualifying event, my wife and I decided that she would not be covered under COBRA coverage and we did not elect COBRA coverage for my wife. Can I add her to the plan at this time?
A     If your wife did not have coverage on another plan when the waiver of COBRA coverage was made, you can add your spouse to the Plan only during the open enrollment period. The spouse will not be considered a qualified beneficiary (because she waived COBRA
at the time of the qualifying event) and if you die, your spouse will not have COBRA continuation rights.
If your wife did have coverage on another plan when COBRA was waived, and lost the other coverage through no fault of her own, she has special enrollment rights and can be covered immediately under your COBRA continuation coverage. Other eligible dependents would have the same special enrollment right if they lost their other plan coverage through no fault of their own. They would not be a qualified beneficiary.

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Notice: This information is prepared exclusively for the use
of clients of 
The Employee Benefit Service Center

Longtime member of the Society of Professional Benefit Administrators (SPBA)

SAS 70 compliant


 
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