What Qualifies You For COBRA?
The federal COBRA law gives workers and their dependents the right to continue their employer-sponsored health insurance if that coverage would end due to a qualifying event such as job loss or family circumstances. You may be eligible depending on your employee status and the size of the employer.
Eligibility Requirements for COBRA
To be eligible for COBRA continuation coverage, you must meet the following requirements:
- Previous Enrollment: You must have enrolled in your employer’s group health plan for at least one day while you were employed.
- Qualifying Event: A qualifying event (other than gross misconduct) that results in losing your employer-based health coverage must occur. Qualifying events include job loss, reduced work hours, divorce or legal separation, or the death of the covered employee.
- Active Health Plan: The employer’s health plan must still be active and provide coverage to current employees. If the plan is discontinued or the employer goes out of business, COBRA coverage may not be available.
- Employee Status: You must have been an employee of a qualified employer that offers a group health plan. The COBRA law applies to employers with 20 or more employees, though some states have their own laws for smaller employers.
Seven COBRA Qualifying Events
There are seven qualifying events under COBRA that can make employees, spouses, or dependents eligible to continue health insurance coverage. The events are grouped into two categories, those that apply to employees and those that apply to family members covered under the employee’s plan.
Qualifying Events for Employees in the Workplace
Changes in the employment status of the covered individual with employer-sponsored health insurance may trigger COBRA eligibility, allowing up to 18 months of continued coverage.
You Quit Your Job
You are covered under COBRA if you quit your job voluntarily. This provides continued health coverage for workers and their qualified dependents after the decision to stop working.
Including Retirement from Work
Retirement is considered quitting your job. You are eligible for up to 18 months of COBRA coverage when you retire.
Laid Off, Furloughed, or Fired from Your Job
Except in the case of gross misconduct, COBRA must be offered to employees who are involuntarily terminated.
Reduced Hours Leading to Loss of Health Insurance
If your health insurance requires a minimum number of hours worked per week, and your hours are reduced, your employer must offer you the option to continue your current insurance under COBRA.
Qualifying Events for Spouses and Dependent Children
Certain life events that change the relationship between the insurance policyholder, their spouse, or other dependents may trigger COBRA eligibility. In these cases, COBRA coverage may be available for up to 36 months.
You Lost Insurance Due to Legal Separation or Divorce
If your family situation changes due to divorce, annulment, termination of a domestic partnership, or legal separation, the affected spouse or dependents may elect COBRA coverage. Be sure to notify your plan administrator when family members should be removed from coverage. Your employer is then responsible for offering the same plan benefits to the separated spouse or partner.
Lost Insurance Due to Loss of Dependent Status at Age 26
Under the Affordable Care Act, adult children can remain on their parent or guardian’s employer-sponsored or marketplace health insurance plan until age 26.
After turning 26, the dependent must secure their own health coverage. If they wish to continue with the same insurance, COBRA allows them to extend their coverage for up to 36 months.
Death of the Covered Employee
If the policyholder passes away, COBRA allows widowed spouses and qualified dependents to continue the group health insurance coverage they had prior to the employee’s death.
Which Employers Must Offer COBRA (Private Sector)
- Employers that had 20 or more employees on more than half of their typical business days in the previous calendar year must offer COBRA.
- Count both full-time and part-time employees toward the 20; each part-time employee counts as a fraction based on hours worked compared with full-time hours.
- COBRA applies only if the employer sponsors a group health plan that provides medical care.
- COBRA must be offered to qualified beneficiaries who were covered under the group health plan on the day before a qualifying event, such as a reduction in hours that causes loss of coverage.
Note for Federal Workers
Federal government plans are not subject to COBRA; federal employees have a similar option called Temporary Continuation of Coverage under the Federal Employees Health Benefits program.
Businesses Exempt from COBRA Continuation
While COBRA provides a continuous health coverage for many employees, certain groups and circumstances are not covered by COBRA continuation laws. Federal COBRA applies only to private-sector employers with 20 or more employees, leaving some individuals ineligible for coverage. Additionally, certain employers and situations are excluded from COBRA coverage:
- Federal Employees: Workers employed by the federal government are not covered under COBRA but may have similar rights under separate federal laws, such as the Federal Employees Health Benefits (FEHB) program.
- Church Employers: Organizations considered church employers are exempt from federal COBRA requirements.
- Small Employers: Businesses with fewer than 20 employees are not required to offer COBRA continuation coverage under federal law.
- Gross Misconduct Exception: Employees terminated due to gross misconduct are not eligible for COBRA coverage.
COBRA Insurance Eligibility Survey
Complete this survey to find out if you are eligible for a COBRA open enrollment period.
Not all qualifying events that may end workplace health insurance are included. It is intended to be helpful.
How Long Does COBRA Last?
When a workplace event separates you from your job, you are allowed a limited time to remain on your employer health insurance according to the COBRA law. Former employees can keep their work insurance up to 18 months. When the qualifying event is family separation event, like death, divorce or separation, the former spouses and dependents are given the right to extend their insurance benefits for up to 36 months.
Frequently Asked Questions: Qualifying Events and Eligibility
- Voluntary or involuntary job loss (not due to gross misconduct)
- Reduction in work hours that impacts eligibility
- Transition between jobs causing temporary loss of coverage
- Divorce or legal separation from the covered employee
- The covered employee becomes entitled to Medicare
- Death of the covered employee
- Dependent child loses eligibility under the plan
You must have been enrolled in your employer’s group health plan and experienced a qualifying event (excluding gross misconduct), such as job loss, hours reduction, divorce, or the covered employee’s death.
Yes. Both voluntary and involuntary job loss (not due to gross misconduct) are qualifying events, and COBRA eligibility applies in either case.
Events like divorce, legal separation, annulment, a dependent child losing eligibility (e.g., turning 26), or the death of the covered employee all qualify individuals for COBRA coverage.
Federal COBRA covers private-sector employers with 20 or more employees. Federal employees, church workers, and employees of businesses with fewer than 20 employees may be excluded from federal COBRA protections.
Some states have Mini-COBRA laws that extend continuation coverage to smaller employers (19 or fewer employees) not covered under the federal law.
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