An employer must offer COBRA coverage if group health benefits are offered to its employees and there are 20 or more employees during 6 months of the preceding calendar year. Controlled groups are aggregated as a single employer when making this decision.

A qualified beneficiary is an individual who is eligible for COBRA continuation coverage if he or she is covered under an employer-sponsored group health plan at least one day prior to the qualifying event. A qualified beneficiary can be either a covered employee, the spouse of a covered employee, or a dependent child of the covered employee.

Once you have received your Specific Rights COBRA Packet in the mail, you will need to look for the COBRA election form. Complete and submit the election form to Admin America, Inc. no later than the last day of the COBRA election period of 60 days. COBRA regulations state you have 60 days from the date you receive the Specific Rights Packet  or 60 days from your last date of coverage as an active employee, whichever is later.

Depending on the scenario, you or your dependents will be eligible for COBRA coverage for either 18, 29, or 36 months.

18 months – If you have lost coverage due to termination of employment or reduction in hours, you and any covered dependents may be eligible to continue COBRA coverage for up to 18 months.

The 18 month continuation period can possibly be extended to 36 months for covered dependents if a second qualifying event occurs. Second qualifying events may include:

• Death of the former employee
• Divorce or legal separation
• Loss of dependent status under the plan.

You must notify Admin America, Inc. if you experience one of these events while under COBRA administration within 60 days of the second qualifying event.

29 months – If you or one of your covered dependents is determined by the Social Security Administration to have been disabled prior to or within the first 60 days of COBRA coverage, you and any covered dependents may be eligible for the disability extension.

To be eligible for the 11-month extension, affected individuals must comply with the notice requirements in a timely manner. Premiums during the additional 11 months of coverage may be at a 50% premium versus the standard 2% premium.

36 months – When covered dependents lose coverage due to death of the employee, divorce or legal separation, loss of dependent status under the plan, or the employee becoming covered by Medicare, they may be eligible to continue COBRA coverage for up to 36 months.

Your initial premium payment must be postmarked within 45 days from the date you sent your election paperwork to Admin America, Inc.

Once Admin America, Inc. processes your initial premium payment, your coverage will be reinstated retroactively back to your first day of COBRA. If Admin America does not receive the premium payment within the required time, you will no longer have access to the continued coverage rights.

Subsequent monthly premium payments are due in full on the first day of each month. However, in accordance with COBRA regulations, you have a 30-day grace period each month in which to make your payment. In order to be considered timely, payments must be postmarked (not necessarily received) within the 30-day grace period. Again, your coverage under the plan will end if payment is not made within the required time.

You can voluntarily request to terminate your COBRA coverage at any time. Other reasons for termination of COBRA Coverage:

• Premium payment is not paid when due.
• After the date of your COBRA election, you and your spouse or dependents become covered under another group health plan.
• After the date of your COBRA election, you, your spouse or dependents become entitled to Medicare.
• Your former employer decided not to provide any group health insurance coverage to any employee.
• If an individual is no longer disabled and was granted the 11 month extension.

COBRA coverage may also be terminated for any reason the plan would terminate coverage.

COBRA participants have the same rights to make changes during an open enrollment period just like current actively covered employees. Depending on the changes made you will have the option to change carriers and/or update coverage tier level. If you would like to make changes during an open enrollment you will need to complete the necessary paperwork and return the paperwork to Admin America within the specified time limit.

According to COBRA laws, active participants on COBRA have the same rights available to active employees with respect to adding new family members due to birth, adoption, or marriage.

Please refer to your health plan SPD for information on who qualifies as an eligible dependent and details on the COBRA election period.