COBRA Continuation Coverage: Factsheet

EMPLOYEE BENEFITS SECURITY ADMINISTRATION
UNITED STATES DEPARTMENT OF LABOR
FACTSHEET www.dol.gov/agencies/ebsa
NOVEMBER 2016
COBRA Continuation Coverage

Throughout a career, workers will face multiple life events, job changes or even job losses. The
continuation coverage provisions of COBRA — the Consolidated Omnibus Budget Reconciliation Act –
help workers and their families keep their group health coverage during times of voluntary or involuntary
job loss, reduction in the hours worked, transition between jobs and in certain other cases.
 COBRA generally requires that group health plans offer employees and their families the opportunity
for a temporary extension of health coverage (called continuation coverage) in certain instances
where coverage under the plan would otherwise end.
 The law generally applies to all group health plans maintained by employers (private-sector and
state/local government) that have at least 20 employees on more than 50 percent of its typical
business days in the previous calendar year. Both full- and part-time employees are counted to
determine whether a plan is subject to COBRA. The law does not apply to plans sponsored by the
Federal Government or by churches and certain church-related organizations.
 Several events that can cause workers and their family members to lose group health coverage may
result in the right to COBRA coverage. These include:
 Termination of the covered employee’s employment for any reason other than gross misconduct;
 Reduction in the covered employee’s hours of employment;
 Covered employee becomes entitled to Medicare;
 Divorce or legal separation of the spouse from the covered employee;
 Death of the covered employee; or
 Loss of “dependent child” status under the plan rules.
 Under COBRA, the employee or family member may qualify to keep their group health plan benefits
for a set period of time, depending on the reason for losing the health coverage. The following
represents some basic information on periods of continuation coverage:
Page 1 dol.gov/agencies/ebsa
FACTSHEET: COBRA Continuation Coverage
Qualified Maximum Period of Continuation

Qualifying Event
Beneficiaries Coverage
Termination (for reasons Employee 18 months (In certain circumstances,
other than gross Spouse qualified beneficiaries may become entitled
misconduct) or reduction in Dependent Child to a disability extension of an additional 11
hours of employment months or an extension of an additional 18
months due to the occurrence of a second
qualifying event.)
Employee enrollment in Spouse 36 months (The actual period of continuation
Medicare Dependent Child coverage may vary depending on factors
such as whether the Medicare entitlement
occurred prior to or after the end of the
covered employee’s employment or
reduction in hours.)
Divorce or legal separation Spouse 36 months

Dependent Child
Death of employee Spouse 36 months
Dependent Child
Loss of “dependent child” Dependent Child 36 months
status under the plan
 However, COBRA also provides that your continuation coverage may be cut short in certain cases.
Notification Requirements
 A general notice must be furnished to covered employees and spouses, within the first 90 days of
coverage under the plan, informing them of their rights under COBRA and describing provisions of
the law. COBRA information also is required to be contained in the plan’s Summary Plan Description
(SPD).
 Under COBRA, the covered employee or a family member has the responsibility to inform the plan
administrator of a divorce, legal separation, disability or a child losing dependent status under the
plan.
 Employers have a responsibility to notify the plan administrator of the employee’s death, termination
of employment or reduction in hours, Medicare entitlement, or bankruptcy of a private-sector
employer.
 When the plan administrator is notified that a qualifying event has happened (by the covered
employee or family member, or by the employer), it must in turn notify each qualified beneficiary of
the right to choose continuation coverage.
 COBRA allows at least 60 days from the date the election notice is provided to inform the plan
administrator that the qualified beneficiary wants to elect continuation coverage.
FACTSHEET: COBRA Continuation Coverage
Premium Payments
 Qualified individuals may be required to pay the entire premium for coverage up to 102% of the cost
to the plan. Premiums may be higher for persons exercising the disability extension provisions of
COBRA. Failure to make timely payments may result in loss of coverage.
 Premiums may be increased by the plan; however, premiums generally must be set in advance of
each 12-month premium cycle.
For More Information

The Employee Benefits Security Administration offers more information on COBRA on its Website,
including Frequently Asked Questions for workers and employers and publications such as:
 An Employee’s Guide to Health Benefits Under COBRA
 An Employer’s Guide to Group Health Continuation Coverage Under COBRA
For copies or to request assistance from a benefits advisor, contact EBSA electronically or call toll free
1-866-444-3272.
This fact sheet has been developed by the U.S. Department of Labor, Employee Benefits Security Administration, Washington, DC 20210. It
will be made available in alternate formats upon request: Voice telephone: 202-693-8664; TTY: 202-501-3911. In addition, the information in
this fact sheet constitutes a small entity compliance guide for purposes of the Small Business Regulatory Enforcement Fairness Act of 1996.

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EMPLOYEE BENEFITS SECURITY ADMINISTRATION

UNITED STATES DEPARTMENT OF LABOR

COBRA Continuation Coverage

Qualified Maximum Period of Continuation

Divorce or legal separation Spouse 36 months

For More Information

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