Eligibility and Qualifying Events For COBRA Continuation Insurance

The Federal COBRA Act 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.

What Are The Qualifying Events For COBRA?

The seven COBRA qualifying events that allow individuals to maintain their employer-sponsored health insurance include termination of employment for reasons other than gross misconduct, reduction in the number of work hours, divorce or legal separation from the covered employee, the covered employee becoming entitled to Medicare, death of the covered employee, loss of dependent child status under the plan, and an employer’s bankruptcy.

COBRA Qualifying Events Overview

  • Voluntary or involuntary termination of employment for reasons other than gross misconduct
  • Reduction in the number of hours worked, affecting eligibility for health insurance
  • Transition between jobs, leading to a temporary loss of health insurance
  • Loss of dependent child status under the plan
  • When the covered employee becomes entitled to Medicare
  • Divorce or legal separation from the covered employee
  • Death of the covered employee

What Makes You Eligible For COBRA?

After a qualifying event, as long as you were enrolled in a group health plan by your former employer which had 20 or more employees, you are eligible for to continue on insurance you were on. This means if you were only insured for 1 day and are let go or quit your job you are entitled to keep the same health insurance after.

How To Apply For COBRA

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Qualifying Events For Employees In The Workplace

Events that change the employment status of the covered individual who holds employer-sponsored health insurance allow up to 18 months of COBRA coverage.

You Quit Your Job

You are covered under COBRA if you quit your job voluntarily. This protects workers and their qualified dependents with continuing health coverage after the covered beneficiary decides to stop working.

… including Retirement From Work

Retirement is viewed as “quitting your job”. You are eligible for up to 18 months on COBRA when you retire.

Lay Off, Furloughed Or Fired From Your Job

Except in the case of gross misconduct, COBRA must be extended to employees that are involuntarily terminated.

Hours Reduced That Would Result In Loss Of Health Insurance

If a requirement of your employer-sponsored insurance is that you work a minimum number hours per week and your scheduled less time, the COBRA law requires the business to provide you an option to continue your same insurance.

Qualifying Events For Spouses and Dependent Children

Events that create a relationship status change between the insurance policy holder, their spouse and other qualified beneficiaries on the health plan. In these situations, you may have COBRA coverage for up to 36 months.

You Lost Insurance Due To Legal Separation Or Divorce

While you are working and if your family changes due to divorce, annulment, termination of a domestic partnership, or legal separation the covered spouse or added dependents are able to elect COBRA insurance. Make sure to keep your plan administrator in the loop on the dates you need to stop coverage when family separates. Your employer should then provide your added spouse or domestic partner the same coverage they had while you were together.

Lost Insurance Due To Loss Of Dependent Status At Age 26

The Affordable Care Act requires that insurance carriers allow adult children to remain covered on their parent or guardian’s employer-sponsored or marketplace health insurance until they are 26 years of age.

At that point, the dependent must find new health insurance. If the former dependent wishes to keep the same health coverage they had, COBRA allows them up to 36 months.

Death Of The Covered Employee

If the policy holder passes away, the COBRA law allows widows and qualified dependents to continue the same group workplace insurance coverage they had previously.

How Long Can You Stay On COBRA?

18 or 36 Months
When a workplace event separates you from your job, you are allowed a limited time to stay on your health insurance with COBRA. 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.

 

Qualifying COBRA Event ​Length of Continuation Coverage
​Reduction of Hours (resulting in loss of coverage) ​18 Months
​Voluntary Termination of Employment (quitting your job) ​18 Months
​Involuntary Termination of Employment (getting fired from job) ​18 Months
​Divorce, Annulment, Termination of Domestic Partnership, or Legal Separation ​36 Months
​Child ceases to be a Dependent (e.g. child turns 26) ​36 Months
​Death of Employee ​36 Months
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Small Businesses Are Exempt From Federal COBRA Continuation Coverage

In general, COBRA coverage is required of all employers with 20 or more employees. Depending on the state you live in, businesses with fewer than 20 workers may be required to offer the same workplace health insurance they had while employed. If you work for a small business you will want to check if your state has a mini-COBRA law to find out if you are eligible.

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