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Health plans and COBRA are not my area of experience. A question has arisen regarding the continuation of COBRA. Can an employer elect can to extend the COBRA coverage past the maximum length of time for certain terminated employees/dependents? Found this on the DOL website. It appears it can be but..... Q11: How long does COBRA coverage last? COBRA requires that continuation coverage extend from the date of the qualifying event for a limited period of 18 or 36 months. The length of time depends on the type of qualifying event that gave rise to the COBRA rights. A plan, however, may provide longer periods of coverage beyond the maximum period required by law. When the qualifying event is the covered employee's termination of employment or reduction in hours of employment, qualified beneficiaries are entitled to 18 months of continuation coverage. When the qualifying event is the end of employment or reduction of the employee's hours, and the employee became entitled to Medicare less than 18 months before the qualifying event, COBRA coverage for the employee's spouse and dependents can last until 36 months after the date the employee becomes entitled to Medicare. For example, if a covered employee becomes entitled to Medicare 8 months before the date his/her employment ends (termination of employment is the COBRA qualifying event), COBRA coverage for his/her spouse and children would last 28 months (36 months minus 8 months). For more information on how entitlement to Medicare impacts the length of COBRA coverage, contact the Department of Labor's Employee Benefits Security Administration at askebsa.dol.gov or by calling 1-866-444-3272. For other qualifying events, qualified beneficiaries must be provided 36 months of continuation coverage. Appreciate any information. Thank you!

I have been fighting with the benefits group of my former employer for the past 7 weeks. I was laid off, opted for Cobra, company paid 2 months and I started paying in month 3 (October). I sent my check in time for the due date, the company received and deposited my check but never applied it to my account. I noticed this a week after the payment was due when I logged into the benefits site to confirm everything was all set. When it showed it wasn't paid, I reached out to check on it and I was told they never received the check so I provided them with a front & back copy of the cancelled check that I had received in my bank statement. Proving that they did in fact receive and deposit the check. I also paid month 4 - November payment which they received, cashed and applied to my account and have paid December which has not yet been cashed or applied but not worried since it is well within the grace period and I believe they are holding it and it will eventually come back to me which will become clear why below. For the past 7 weeks I have been getting the run around from the company claiming (A) The check was not received (I provided copy 5 days after they deposited it) (B) They sent the check back to me (they gave no reason why, just that it wasn't applied because they sent it back to me. Reminded them that I uploaded a copy of the front/back of the cashed check so they couldn't have sent it back to me) (C) They sent a refund check to me (I asked for details of when, where & to whom they sent it as well as a copy of front/back of the refund check if it had been cashed - I've gotten no response). (D) They credited my bank account (asked for details including the bank routing #'s and account that they credited and a copy of the receipt for the deposit to my account and the reason for the return of the funds - crickets because it didn't happen). (E) The check was returned for insufficient funds 6.5 weeks ago (This one was my favorite!!! I asked for a copy of the ISF notice they received - once again, it didn't happen because I got the cancelled check back in my statement showing it was paid to their account ). I also received two statements in November, the first just before Thanksgiving, showing the October & November payments and only December due - generated after I called to question the payment and showed proof of payment and the second generated after Thanksgiving and the October payment has been removed again. Last week I gave until Friday afternoon to resolve this or I would file a complaint with Department of Labor COBRA division - On Sunday evening, yesterday, my insurance was cancelled without notice. I immediately opened a claim with DOL, uploaded all my proof of payment, copies of conversations (including the excuses) and statements of amounts owed. They called me back this morning and got to work contacting the former employers corporate lawyer. I also had surgery scheduled for today and DOL contacted the hospital where I was to have the surgery and made sure they knew the insurance was cancelled in error and the hospital agreed to continue the surgery. GO DOL!!! My concern is now that they have cancelled my insurance due to their error that they have refused to fix, does anyone know how long it takes to be reinstated, I cannot get an answer from the worlds worst employer and what about my 2025 insurance? I have previously elected COBRA for my 2025 coverage but if they take this past the final signup date, can they screw me on that too? I am concerned that they are holding the December check and will return it to me at some point since I no longer have active insurance. I am prepared to send a second check for December if/when the check comes back uncashed or sooner so they have it in hand when the insurance is reinstated and to avoid them saying that my payment was out of the grace period. I can't imagine this is legal, cashing my check but not paying my insurance and I understand that mistakes happen but I spoke to no less than 5 different people who all came up with a different, ridiculous excuse for why it was not applied, each excuse instantly proved false by the cancelled check I uploaded to their system weeks ago. I've been told for the past 2 weeks that they are escalating this to the leadership team for review and finally today, after DOL got in touch with their corporate benefits lawyer that "We went through the check images you provided, and are escalating to the bank processor for further review of the October payment." Can they be fined by DOL? Pay a hopefully hefty penalty? Do I have other recourse or based on experience, should I be comfortable that they will reinstate my insurance and stop playing games? I give props to DOL, they reacted quickly and totally took care of me today and I have faith in the DOL rep but no faith in the worlds worst employer who after speaking with 5 different people, getting 5 different excuses and taking 7 weeks with nobody truly looking at this I have two options: Believe these are the most incompetent workers ever hired anywhere or this company is purposely doing this to ex-employees to screw up our insurance. Disclaimer: Writing this on pain killers after surgery today, I realize it's lengthy, I hope it makes sense

Looking for thoughts on whether the Virta diabetic add on program would be subject to COBRA. I'm inclined to say no, that it is an independent, non-coordinated benefit (disease-specific, excepted benefit, but wanted to see what everyone else's thoughts are. Thank you!

I have an individual client who's employer is stating he voluntarily terminated employment because of job abandonment. However, he did not abandon his job but left (with the employers permission) on a Tuesday after they refused to pay him a commission on a large deal which violated his employment agreement because he was very upset. His attorney sent the employer a demand letter the next day requesting how they were changing his prior employment agreement and indicated the employee would be taking vacation days until the employer responded. The issue is that employer is stating he voluntarily resigned when he didn't and wanted to remain working there but couldn't get them to agree that they were changing his employment agreement. He elected COBRA, (the employer has less than 20 employees so it officially falls under the state continuation plan) but without knowing the monthly premium cost. When he received the amounts($3,400/month for he and his family), he did not proceed with COBRA and didn't make any payments. He is still within his COBRA eligibility window and therefore submitted his request for treatment as an AEI, but the employer returned it to him denying coverage due to "loss of employment was voluntary". The DOL/EBSA cannot assist because they don't have jurisdiction over state continuation plans and his state department of insurance is indicating they can only help with Insurance Company or Agent issues. Does anyone have any suggestions on how he can either get this resolved or where he can get legal assistance? Most of the law firms he has spoken to deal with employers and not individuals so he's at a loss of where to turn. Thanks in advance for your thoughts! C

Scenario: Employee's spouse's employment was terminated. She is eligible for 12 months of fully subsidized COBRA continuation coverage followed by an additional six months of unsubsidized coverage as required by COBRA. The spouse is nearing the end of the 12-month period of subsidized coverage and the employee wants to enroll the spouse in his employer's plan effective at the end of subsidized period. HIPAA's special enrollment rights would, in general, permit the employee to enroll the spouse in his plan in lieu of her electing COBRA (i.e., 12 months ago) and again at the end of the 18-month COBRA period. But there is, in general, no special enrollment right to add coverage in the middle of COBRA continuation coverage. In the COVID-19 relief (which in my view was not the previous Administration's best effort), the requirement that a participant inform an employer of a special enrollment right within 30- or 60-days (depending on the event) is tolled until basically the end of the pandemic. Must the employer permit the employee to enroll his spouse in the plan as he requests because the notification requirement is tolled? Or did the employee's special enrollment right for his spouse go away when she elected subsidized COBRA? Any thoughts are appreciated.

If an employee who his 66 years old and on Medicare retires on Jan. 1, and his spouse is not yet eligible for Medicare wants to carry COBRA, how long can the spouse carry COBRA?

Can an employer offer longer COBRA duration, for example 30 months instead of 18 for a class of employees - executives, or salaried but not hourly? Assume that the employer does not subsidize the premium.

Company acquires sub of seller via an asset purchase transaction and decides to employ certain of the sub's employees following close of the transaction. Buyer is an ALE. There will be a lag time until Buyer gets plans in place for the acquired employees (it's putting separate plan in place for the acquired employees). Buyer is considering paying for acquired employees' COBRA under Seller's plan on a tax-free basis. Any thoughts as to whether this will work, or what issues it may raise? What about the ACA concerns? Thanks in advance.

Can anyone provide some guidance on how (or whether) a employer sponsor of a self-insured plan reports on Form 1095-C with respect to employees who terminated employment prior to 2015 but participated in the plan by reason of COBRA for all or a part of 2015? Are they reported the same way as employees who terminated in 2015 are reported for the portion of the year in which they were on COBRA? Thanks.

This is the first sentence of the text of the model COBRA Election Notice as revised by the DOL to incorporate information about the availability of coverage in the Marketplace. I am copying it verbatim from the DOL website: This notice has important information about your right to continue your health care coverage in the [enter name of group health plan] (the Plan), as well as other health coverage options that may be available to you, including coverage through the Health Insurance Marketplace at www.HealthCare.gov or call 1-800-318-2596. (The underscore/underlined text after "call" is as in the original.) It seems to me as if there are words missing after the word "Marketplace" because the sentence does not make grammatical sense as written (although the intent of the sentence is obvious). I have not seen any discussion of this. Has anyone encountered this? If so, what, if any changes did you make to this language when customizing it for actual use? Thanks.

Employer has an existing severance pay plan covering all employees for both involuntary and voluntary separation from service. Plan does not qualify for 2 /2 separation pay plan exception because it pays on voluntary termination as well as involuntary. Lump sum severance benefit is service-based and terms comply with 409A. Plan also provides that employer will pay COBRA premiums (again for ALL employees) for the period used to determine severance (and this is always shorter than COBRA continuation period). They now want to eliminate the health coverage continuation premiums and instead pay an additional lump sum benefit at the same time as the existing lump sum benefit. Not trying to get out of paying employees, but want to make it easier to administer and they envision that the company may stop offering health insurance altogether as it winds down operations. The medical coverage should be exempt from 409A - meaning it isn't deferred compensation because it is a nontaxable benefit (or in the alternative, qualifies under the Medical benefits exception for separation pay plans that limit reimbursements to the COBRA continuation period. So I am thinking that eliminating this benefit and replacing it with a lump sum benefit would not be a substitution of deferred compensation that would result in an acceleration because it wasn't deferred compensation in the first place. Any one see any problems with this approach?

An employer was paying for the first month of a former employee"s COBRA. The former employee sent his COBRA election letter to the former employer instead of the administrator. The employer paid the first month premium. The administrator cancelled the former employee"s COBRA because they did not receive the former employees election. Does the election notice by the former employee to the former employer count as notice of the election? The election notice was sent to the employer 8 days after receipt of the COBRA notice.

An employee is requesting information on the COBRA implications of her entry into a partial dissolution of marriage (or "bifurcated divorce") under California Family Code s. 2337, pursuant to which I believe a ruling on dissolving the formal marital status is made ahead of resolving other (eg financial) issues: http://www.leginfo.ca.gov/cgi-bin/displaycode?section=fam&group=02001-03000&file=2330-2348 Anyone have any experience as to whether a bifurcated divorce ruling would constitute a "divorce" or "legal separation" (both COBRA qualifying events under our plan)? Bonus points for Calfornia practitioners but any state would be helpful. Note this is a separate question from whether the employee will remain financially responsible for providing health coverage pending total dissolution - the CA Family Code suggests that this could be addressed in the ruling, so the only question in my mind is whether the coverage (if any) should be provided as regular spousal coverage or through COBRA. Thanks for any guidance!

I know that under the FMLA, participants on unpaid FMLA leave have reinstatement rights immediately upon return to active employment, but what about other "terminations for nonpayment" -- For example, if someone is on non-FMLA unpaid leave or if someone's payroll amount is not sufficient to cover the employee share of the premiums? If that individual is terminated from coverage for nonpayment and later begins paying again... (1) Does that person have to pay up all arrearages before being reinstated? Or do they just have to pay going forward (and have their coverage canceled retroactively)? (2) What if that person has a qualified life event during the period he/she is not covered? For example, if that person got married during an unpaid LOA and seeks to be reinstated... would that person be eligible for an election change immediately upon reinstatement? (3) What if that person is terminated while on unpaid LOA and benefits were terminated for nonpayment... ignoring any other legal issues, would that person be entitled to COBRA if they were not participating on the date of termination?

I was released from a large company on 8/31/13 and offered COBRA coverage accordingly. None of the notifications or the plan summary description make mention of a need for my 67 year old husband to become entitled to (sign up for) Medicare part B to receive identical coverage. In our coverage the day before I was released, he did not have Medicare B. At the end of December we learned my husband would need surgery. The first week of January, I called the provider to verify our coverage & maximum out of pocket for him. The reply I received that day was in line with what I understood our existing coverage to be. I called again a few weeks later to see why claims weren't being paid as usual. I disclosed that we were COBRA and that he had Medicare part A, but not part B. I was told that they would resubmit for payment, it would take 30 days. I called several times to monitor status on this. Until 3/11, the answers were that it was in process, it would be 30 days. After 30 days was up, the answer was that review was complete and that it would take an additional 30 days for full correction. Last Tuesday, on 3/11/14, I was informed that because he is "eligible" for Medicare, they will only be paying 20% rather than filling the gap for part B. He is indeed eligible for part B, but he is not entitled to part B. Since he was under my insurance plan 2 years ago when he became eligible, he declined, so is not entitled. Nevertheless, his coverage has changed from the day before I was terminated to a 20% limit. There is no indication of this possibility in any of the COBRA documentation or summery plan description. I have been searching for information on COBRA & Medicare. My understanding of the law is that it pertains to entitlement, not eligibility. If he had signed up for Part B, he would be entitled. Since he didn't, he is only eligible. I've talked with both the company (self insured) and the carrier about this. They are both sticking to the "eligibility" status as reason for declining coverage now although there has been a variety of answers to this from both of them. The first surgery was double hernia on 1/10/14 after my initial call to the carrier. During pre-op workup, we discovered he had a large dissected aneurysm and leaking valve. He had open heart surgery on 2/10/14. We are now being informed we are responsible for a gap mounting into tens of thousands of dollars. I think they are confused about entitlement vs eligibility. The last company rep I talked to said there have been other cases like this. My questions are: Is there a COBRA exclusion that allows them to require Medicare B entitlement or a change in coverage like this? If not, what recourse do I have? If there is a COBRA exclusion that makes this legal, do I have recourse with the carrier who gave me incorrect information for 2 months while we incurred extensive medical bills? Thank you, Sue B

Can an employer automatically enroll terminated employees in COBRA? The employer wants to automatically enroll severed employees - the employer will pay for the COBRA coverage for a limited period. At the end of the period, participants could either opt-out or just not pay for continued coverage (at which point, the COBRA coverage would terminate). The employer's COBRA vendor has said they do this frequently with other clients, I can find no authority to permit this. Thank you in advance for any help!