COBRA Notification procedures and election

Under COBRA, group health plans must provide covered employees and their families with certain notices explaining their COBRA rights. They should also have rules about how to offer continuation coverage under COBRA, how can choose continuation coverage qualified beneficiaries and when it may be canceled.

Procedures for notification of COBRA

Summary plan description
COBRA rights provided under the plan, as well as other important information regarding the plan will be listed in the summary plan description (SPD). This brief is a written document that provides important information about the plan, including what benefits are available under the plan, the rights of participants and beneficiaries under the plan and how the plan works. ERISA requires group health plans will provide each participant an SPD within 90 days of joining a plan (or within 120 days after the plan is first subject to notification and disclosure provisions of ERISA) . 

 

What happens when there is a change to a COBRA plan?

Moreover, in case of substantial changes to the plan, the plan must give participants a summary of material modifications (SMM) not later than 210 days after the end of the plan year during which the changes were made effective. If the change is a material reduction in covered services or benefits, the SMM must be provided no later than 60 days after the reduction is adopted. A participant or beneficiary covered under the plan may request a copy of the SPD and any SMM (and any other document pertaining to the plan), which must be provided within 30 days of a written request.

 

General Notice of COBRA Coverage

Group health plans must give each employee and each spouse of an employee for which coverage begins under the plan for a general notice describing the rights under COBRA. The general notice must be provided within the first 90 days of coverage. Group health plans can satisfy this requirement by giving you the SPD plan within that period, provided it contains information of a general notification.

 

What is a COBRA general notice?

The COBRA general notice must contain the information you need to protect your rights under COBRA when your coverage under the plan, including the name of the plan and the person you can contact for more information, a general description of the continuation coverage provided under the plan and an explanation of any notice shall provide the plan to protect your rights under COBRA.

 

Event notifications under COBRA Qualification

Before a group health plan must offer continuation coverage, a qualifying event shall occur and shall notify the group health plan of the qualifying event. Who shall provide notice of the qualifying event depends on the type of qualifying event.

 

The employer must notify the plan if the qualifying event is:

  • Cancellation or reduction of hours of employment of the covered employee;
  • The death of the covered employee;
  • The start of eligibility for benefits covered by Medicare employee; or
  • The insolvency of their employer.

The employer has 30 days after the event occurs to provide notice to plan.

You (the covered employee or one of the qualified beneficiaries) must notify the plan if the qualifying event is:

  • Divorce;
  • Legal separation; or
  • The loss of the classification of a child as a dependent under the plan.

You must understand the rules of your plan about how to present notifications if one of these qualifying events happens. The plan should have procedures on how to report a qualifying event and procedures should be described both as a general notice on the plan’s SPD. The plan can set a limit to provide this notice time, but the time limit can not be less than 60 days, starting with whichever occurs later: the date on which the qualifying event occurs (1); (2) the date you lose (or lose) coverage under the plan as a result of a qualifying event; or (3) the date on which it is informed, through the provision of an SPD or a COBRA general notice on the responsibility to notify the plan and procedures for doing so.

 

Notice of Qualifying Event

If your plan does not have reasonable procedures on how to provide notice of a qualifying event, you can provide your notice by the person or unit from your employer that manages the affairs of the employer regarding employee benefits. If your plan is a multi-employer plan, also may provide the notice to the joint board of trustees and, if the plan is administered by an insurance company (or if benefits are provided through insurance) may be provided the notice to the insurance company.

 

COBRA Notice of election coverage

After receiving a notice of a qualifying event, the plan must provide notice of qualified election, which describes their rights to continuation coverage and how to make a choice to beneficiaries. The notice must be provided to qualified within 14 days after the plan administrator receives the notice of a qualifying event. The election notice must contain all the information you need to understand continuation coverage and to make an informed decision about not choose or continuation coverage. You must also provide the name of the COBRA plan administrator and explain how to get more information.

 

COBRA Notice the lack of availability of continuation coverage

group health plans may sometimes deny a request for continuation coverage or for an extension of continuation coverage. If you or any family member applying for continuation coverage and the plan determines that you or your family are not entitled to continued coverage requested for some reason, the plan must provide the person who made ​​the request a notification about the unavailability of continuation coverage. The notification shall be provided within 14 days of receiving the request, explaining the reason why it was denied.

 

COBRA Notice of Early Termination of Continuation Coverage

Continuation coverage must generally be provided for a period (18, 29 or 36 months). The group health plan may terminate continuation coverage earlier form, however, by any of several specific reasons.  When a group health plan decides to terminate continuation coverage early for any of these reasons, the plan must give the qualified beneficiary a notice of early termination . The notice must be given as soon as practicable after taking the decision and shall describe the date coverage ends, the reason for cancellation and any rights you may have qualified beneficiary under the plan or under the law applicable choice alternative group or individual coverage, such as the right to convert to an individual policy.

 

Special rules for multiemployer plans

are allowed to multiemployer plans to adopt some special rules for notifications regarding COBRA. First, a multiemployer plan may adopt its own limits of uniform deadline for qualifying event notice or the election notice. A multiemployer plan may also choose not to require employers to provide qualifying event notices and that the plan administrator who determines when a qualifying event has occurred. Any special rules regarding multiemployer plans must be established in the plan documents (and SPD).