COBRA generally gives qualified beneficiaries the right to continue employer-sponsored group health coverage after certain qualifying events. For termination of employment, other than gross misconduct, or a reduction in work hours, the standard maximum continuation period is generally 18 months. Other qualifying events, such as death of the covered employee, divorce, legal separation, or a dependent child’s loss of dependent status, may result in a longer maximum continuation period, commonly 36 months.
Continuation coverage is not free coverage. The qualified beneficiary typically pays the full group premium plus a permitted administrative charge. COBRA can preserve the same group coverage and provider access for a limited time, but it may be expensive because the employer is no longer subsidizing premiums. Enrollment deadlines, election notices, payment rules, and employer-plan size requirements are important.
COBRA should not be confused with conversion coverage or an Affordable Care Act marketplace plan. Conversion coverage is an individual policy issued after group coverage ends under stated conditions. Marketplace coverage is a separate individual-market option that may be available following loss of employer-sponsored coverage. Producers should explain options carefully and avoid presenting one continuation route as automatically best for every consumer.
References/topics from the Study Guide: COBRA; Group Health Continuation; Qualifying Events; Conversion Privilege; Employer-Sponsored Health Insurance.
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