Health care coverage is a hot button issue for New Jersey residents and people across the nation. Protections that are given to workers via the Consolidated Omnibus Budget Reconciliation Act are vital for those who are at risk of losing their coverage. COBRA gives a temporary continuation of the plan the person was on if it would otherwise end. Understanding who is eligible for COBRA is essential when there is a chance that benefits will be lost.
For a person to use COBRA, the following must be in place: the group health plan must be covered by it; there must be a qualifying event; and the person must be a qualified beneficiary for the event. Those who are in a health plan that was sponsored by an employer – whether it was private or state or local government – that had a minimum of 20 employees during more than half of its typical business days in the prior calendar year can use COBRA. When the number of employees is calculated, full and part-time workers are part of the process. A part-time employee will be considered a fraction of a worker who is employed full-time. There is a formula that is used to come to a total number of workers.
A qualifying event is one that will result in the person losing their health coverage. They include: termination of employment for any reason except for gross misconduct; or a reduction in the hours the person works. For the person’s spouse or a dependent child, the above reasons are applicable as are the following: the covered worker is entitled to receive Medicare; there is a divorce or legal separation from the person who was covered; or the covered employee dies. A dependent child can be considered as falling under the qualifying event category if the status as a dependent child is lost. The Affordable Care Act allows children to remain on a parent’s plan until age 26.
Qualified beneficiaries must be covered the day before the qualifying event happens. This depends on the event and who is seeking COBRA. It can be a spouse, former spouse or dependent child. Situations such as employer bankruptcy can allow more beneficiaries, such as a retired employee, their spouse or former spouse, and dependent children. People who are concerned about health plan protections should be aware of the requirements to get COBRA. If there are issues or concerns with COBRA, a legal professional who is experienced with ERISA can be of assistance.
Source: dol.gov, “FAQs on COBRA Continuation Health Coverage,” accessed on Sept. 25, 2017