An Employee’s Guide to COBRA Health Benefits

Introduction

Health plans help workers and their families take care of their basic medical needs. It is one of the most important benefits an employer can offer.

Under the Consolidated Omnibus Budget Reconciliation Act ( COBRA ), many employees and their families who lose eligibility for group health insurance due to serious life events can continue to participate in their employer’s group health plan for a limited time, but usually at their own expense.

This booklet explains your rights under COBRA , a temporary extension of employer-provided group health insurance, called COBRA continuation coverage. It will:

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Provide a general explanation of your COBRA rights and responsibilities;
Outlining the COBRA rules that group health plans must follow ;
Emphasizes your rights when accepting COBRA continuation coverage.

What is COBRA continuation coverage?

The Consolidated Omnibus Budget Reconciliation Act ( COBRA ) requires most group health plans to provide temporary continuation of group health insurance or risk termination. COBRA requires most group health plans to provide continuation of coverage to covered employees, former employees, spouses, former spouses, and dependent children or risk losing group health insurance due to certain events. These events include:

Death of an insured employee,
The covered employee loses his/her job or has his/her working hours reduced due to reasons other than serious misconduct.
Insured employees are entitled to medical insurance.
A covered employee is divorced or legally separated, and
The child loses dependent status (and therefore eligibility for coverage) under the plan.

Employers can require individuals who choose continuation coverage to pay the full cost of coverage, plus a 2% administrative fee. Continuation premiums are usually more expensive than the amount an active employee would have to pay because employers usually pay part of the cost of an active employee’s coverage. COBRA continuation coverage lasts only for a limited time.

COBRA generally applies to all health insurance plans maintained by private-sector employers with at least 20 employees or by state and local governments. However, the law does not apply to plans sponsored by the federal government or by churches and certain church-related organizations. Many states have laws similar to COBRA , including those that apply to health insurers of employers with fewer than 20 employees (sometimes called mini- COBRA ). Check with your state insurance commissioner’s office to see if this coverage applies to you.

Under COBRA , a group health plan is any arrangement made or maintained by an employer for the purpose of providing health care services to employees or their families, whether provided through insurance, provided by a health maintenance organization, deducted from the employer’s assets, or provided in any other manner. “Health care services” for this purpose include:

Inpatient and outpatient care,
Doctor care,
Surgery and other major medical benefits,
Prescription drugs, and
Dental and vision care.

Life insurance and disability benefits are not considered “medical services.” COBRA does not apply to plans that provide only life insurance or disability benefits.

COBRA group health plans sponsored by private sector employers are generally subject to the Employee Retirement Income Security Act ( ERISA ). ERISA does not require employers to set up plans or to provide any specific type or level of benefits, but it does require plans to follow ERISA ‘s rules. ERISA also gives participants and beneficiaries legally enforceable rights.

Alternatives to COBRA Continuation Coverage

If you are eligible to choose COBRA continuation coverage, you should consider all of your options before making a decision. There may be more affordable or generous health insurance options for you and your family through other group health plan coverage (such as your spouse’s plan), Marketplace coverage® , Medicare , or Medicaid .

Under the Health Insurance Portability and Accountability Act ( HIPAA ), if you or your dependents lose eligibility for group health insurance, including continuation coverage, you may be able to enroll in other group health insurance through a special enrollment period without having to wait until the next open season. For example, an employee who loses group health insurance can enroll in a spouse’s plan through a special enrollment period, or a dependent who loses group health insurance eligibility can enroll in another parent’s plan. To be eligible for a special enrollment opportunity, you or your dependents must have previously qualified for the plan you now want to enroll in and had other health insurance when the plan was first offered to you. You must request a special enrollment within 30 days of losing your other coverage.

Losing your job-based health insurance also gives you an opportunity to enroll in a Marketplace plan. The Marketplace plan allows you to search for and compare private health insurance options. With Marketplace plans, you may qualify for tax credits to lower your monthly premiums and cost-sharing, and reduce your deductibles, coinsurance, and copayments.

Getting COBRA continuation coverage does not limit your eligibility for Marketplace coverage or tax credits. You can apply for Marketplace coverage at HealthCare.gov or by calling 1-800-318-2596 (TTY 1-855-889-4325 ). To enroll in a Marketplace plan specifically, you must choose a plan within 60 days before or after you lose coverage at work . Also, anyone can enroll in Marketplace coverage during open enrollment. If you need health insurance between losing your job coverage and starting coverage through the Marketplace (for example, if you or a family member needs medical care), you may want to choose COBRA coverage from your former employer’s plan. Then they both have health insurance until coverage starts under the Marketplace.

With Marketplace insurance, you can also find out if you qualify for free or low-cost insurance through Medicaid or the Children’s Health Insurance Program (CHIP). You can apply for and be enrolled in Medicaid and the Children’s Health Insurance Program at any time. If you qualify, your coverage starts immediately. Visit HealthCare.gov or call 1-800-318-2596 (TTY 1-855-889-4325 ) to learn more or apply for these programs. You can also apply for Medicaid by contacting your state Medicaid office and learn more about the children’s health insurance program in your state by calling 1-877- KIDS NOW (543-7669) or visiting InsureKidsNow.gov .

If you or your dependents have chosen COBRA continuation coverage, you can request special enrollment in another group health plan or Marketplace plan if a new special enrollment event occurs, such as marriage, birth of a child, or COBRA coverage expires. COBRA coverage expiration is the maximum period that you or your dependents must receive COBRA coverage without early termination. Keep in mind that if you choose to terminate your COBRA coverage early and there is no special enrollment opportunity at that time, you will have to wait until the next open enrollment period to enroll in coverage through another group health plan or Marketplace plan.

Medicare is the federal health insurance program for people 65 years of age or older and certain younger people with disabilities or end-stage renal disease. Generally, if you lose your job after your initial Medicare enrollment period and are not enrolled in Medicare Part A or Part B, you have an 8-month special enrollment period starting on the earlier of:

the month your employment ended; or
The month after your group health insurance ends.

If you choose COBRA coverage instead of Medicare, you may have to pay a late enrollment penalty and may have a gap in coverage if you later decide you want to buy Part B. If you enroll in Medicare Part A or B before your COBRA coverage ends, your plan may terminate your continuation coverage. But if Medicare Part A or B is in effect on or before the date you choose COBRA , your plan cannot terminate your COBRA coverage because of Medicare’s rights, even if you enroll in another part of Medicare after you choose COBRA coverage .

Generally, if you are enrolled in both COBRA and Medicare, Medicare will be the primary payor and COBRA coverage will pay secondary. The secondary payor may not pay for all uncovered expenses. Some plans may serve as a secondary payor for Medicare even if you are not enrolled in Medicare. For more information, visit medicare.gov/medicare-and-you .

Who is eligible for continuation coverage?

You must meet three basic requirements to be eligible for COBRA continuation coverage:

Your group health plan must be covered by COBRA ;
A qualifying event must occur; and.
You must be a qualified beneficiary of the event .

Plan coverage

COBRA covers group health plans sponsored by an employer (private sector or state/local government) that had at least 20 employees who worked more than 50 percent of their typical workdays in the previous calendar year. Both full-time and part-time employees are counted to determine whether a plan is subject to COBRA . Each part-time employee is counted as a fraction of a full-time employee, which is equal to the number of hours worked divided by the number of hours the employee must work to be considered full-time. For example, if a full-time employee at Company A works 40 hours per week, a part-time employee who works 20 hours per week is counted as half of a full-time employee, while a part-time employee who works 16 hours per week is counted as four-tenths of a full-time employee.

Qualifying Events

A “qualifying event” is an event that causes an individual to lose group health insurance. The type of qualifying event determines who is an eligible beneficiary and how long a plan must provide continuation coverage. COBRA only sets minimum requirements for continuation coverage. Plans can always choose to provide continuation coverage for a longer period of time and/or pay for it.

The following are some of the events that would cause a covered employee to lose coverage and make the covered employee eligible:

terminate the employment of a covered employee for any reason other than “serious misconduct”, or
A reduction in the working hours of covered employees.

The following are some of the events that would cause a covered employee’s spouse and dependent children to lose coverage and qualify as spouses and dependent children :

Termination of the covered employee’s employment for any reason other than “serious misconduct”,
The insured employee’s working hours are reduced,
Covered employees are eligible for Medicare.
The covered employee is divorced or legally separated, or
Death of a covered employee.

In addition to the above, the following are events that would cause a dependent child to lose coverage and make the child eligible:

Loss of “dependent child” status under the plan. The Affordable Care Act requires that a child’s insurance plan, in addition to the parent’s plan, remain in effect until the child turns 26.

Eligible Beneficiary

A qualified beneficiary is an employee who was covered by a group health plan as a covered employee or the spouse, former spouse, or dependent child of a covered employee on the day before a qualifying event. Only certain individuals can become qualified beneficiaries based on a qualifying event, and the type of qualifying event determines who can become a qualified beneficiary after the event occurs. A qualified beneficiary must be a covered employee, the employee’s spouse or former spouse, or the employee’s dependent child. In certain circumstances, retired employees and their spouse, former spouse, or dependent children can become qualified beneficiaries in the event of an employer’s bankruptcy. In addition, children born or adopted by covered employees during the period of continuation of coverage are automatically considered qualified beneficiaries. Agents, independent contractors, and directors of employers participating in group health plans may also become qualified beneficiaries.

COBRA Notification and Election Process

Under COBRA , group health plans must send specific notices to covered employees and their families explaining their COBRA rights. Plans must also include procedures for how to provide COBRA continuation coverage, how eligible beneficiaries can elect to continue coverage, and when coverage can be terminated.

Notification Procedure

Program Summary Description

The Summary Plan Description ( SPD ) must explain the COBRA rights provided in the plan . The SPD is a written document that provides important information about the plan, including the benefits available under the plan, the rights of plan participants and beneficiaries, and how the plan works. ERISA requires group health plans to send you an SPD within 90 days of you joining the plan (or within 120 days of ERISA becoming applicable to the plan). In addition, if there are material changes, the plan must send you a Summary of Material Modifications ( SMM ) within 210 days of the end of the plan year in which the changes take effect . If a participant would consider the change to be a substantial reduction in covered services or benefits, the plan administrator must provide the SMM within 60 days of implementing the reduction. If a covered person or beneficiary requests a copy of these or any other plan document in writing, the plan administrator must provide it within 30 days.

COBRA General Notice

Group health plans must give each employee and spouse a general notice describing COBRA rights within the first 90 days of coverage. Group health plans can meet this requirement by including the general notice in the plan’s SPD and giving it to you and your spouse within this time frame.

The general notice must include:

The name of the plan and the name, address, and telephone number of a person you can contact to learn more about COBRA and the plan;
A brief description of the continuation coverage provided under the plan, and
Explain what you must do to notify the plan of a qualifying event or disability.

Notification of COBRA Qualifying Event

If a qualifying event occurs, group health plans must provide continuation coverage. An employer, employee, or beneficiary must notify the group health plan of a qualifying event, and the plan does not need to take action until it receives proper notice. Who must give notice depends on the type of qualifying event.

The scheme must be notified by the employer if the following qualifying events occur :

Termination or reduction of working hours of covered employees,
Death of an insured employee,
The covered employee is eligible for Medicare, or
The employer goes bankrupt.

The employer must notify the plan within 30 days of the incident.

You (the covered employee or one of the eligible beneficiaries) must notify the plan if one of the following qualifying events occurs :

divorce,
Legally separated, or
The child loses dependent status under the plan.

You should understand your plan’s rules for providing notice when these qualifying events occur. Group health plans must set out procedures in the general notice and SPD that describe how you provide notice of these types of qualifying events. Plans can set a time limit for providing this notice, but the time limit cannot be less than 60 days from the latest of the dates listed below.

the date on which the qualifying event occurred,
The date you lose (or are about to lose) plan coverage due to a qualifying event, or
By providing an SPD or COBRA general notice, you are informed of your obligation to notify the plan and the dates of the notification procedures.

If your plan does not include reasonable procedures for providing notice of a qualifying event, you may provide notice by contacting the person or department that handles employee benefits for your employer (e.g., the human resources department). If your plan is a multiemployer plan, you may also provide notice to the Joint Board of Trustees, and if your plan is administered by (or provides benefits through) an insurance company, you may provide notice to the insurance company.

COBRA Election Notice

If a plan receives notice of a qualifying event, it must provide a notice of election to qualified beneficiaries within 14 days. The notice of election explains their rights to continuation coverage and how to make an election. The notice should contain all the information you need to understand continuation coverage and make an informed decision about whether to elect continuation coverage. The notice should also provide the name of the plan’s COBRA administrator and tell you how to get more information.

Notice of Failure to Provide Continuation of COBRA Coverage

Group health plans may sometimes deny requests to continue coverage or extend coverage. When a plan denies a request to renew or extend coverage for you or any family member, the plan must provide you or your family member with a notice within 14 days of receiving the request that you are unable to obtain continued coverage and explain the reasons for the denial.

Notice of Early Termination of COBRA Continuation Coverage

Continuation coverage generally must be for a maximum term (18, 29, or 36 months). However, a group health plan can terminate continuation coverage early for any specific reason. (See “Terms of Continuation Coverage” on page 9.) When a group health plan decides to terminate continuation coverage early for any of the reasons listed above, the plan must provide an early termination notice to eligible beneficiaries. The notice must be given as soon as possible after the decision is made and must state the date the coverage is terminating, the reason for the termination, and any rights the eligible beneficiary may have under the plan or applicable law to elect other group or individual coverage.

Special Rules for Multiemployer Plans

Multiemployer plans are permitted to adopt some special rules for COBRA notices. First, a multiemployer plan may adopt its own uniform time limits for qualifying event notices or election notices. A multiemployer plan may also choose not to require employers to provide qualifying event notices and instead leave it to the plan administrator to determine when a qualifying event occurs. Any special multiemployer plan rules must be outlined in the plan documents (and the SPD ).

Select a program

Plans must give you at least 60 days to elect to participate in COBRA coverage, starting from the later of the date you receive notice of your election or the date you lose eligibility for group health plan coverage due to a qualifying event.

Each qualified beneficiary has an independent right to elect continuation coverage. This means that if you and your spouse both have the right to elect continuation coverage, you can each make a different election. However, if a plan does not specify that it is individual-only coverage, the plan must allow you or your spouse to elect continuation coverage on behalf of all other qualified beneficiaries for the same qualifying event. The plan must also allow a qualified beneficiary’s parent or legal guardian to make an election on behalf of a minor child.

If you waive continued coverage during the election period, you must be allowed to do so as long as you revoke the waiver and elect continued coverage before the end of the election period. In this case, the plan can allow continued coverage to begin on the date you revoke the waiver.

Certain Trade Adjustment Assistance ( TAA ) program participants have the opportunity to re-elect COBRA continuation coverage:

Individuals who are eligible for and receive trade adjustment allowances,
Individuals who are eligible for trade adjustment benefits but have not exhausted their unemployment insurance benefits, and
Individuals who receive other Trade Adjustment Assistance or Reemployment Trade Adjustment Assistance benefits and who did not elect COBRA during the general election period .

This second election period is a 60-day period that begins on the first day of the month in which the individual is determined eligible for TAA benefits described above and receives such benefits. For example, if an eligible individual’s general election period ends at the beginning of the month, they would have approximately 60 more days to elect COBRA . However, if the same individual meets the eligibility criteria at the end of the month, the 60 days would still begin on the first day of the month, effectively giving the individual approximately 30 days. You must elect COBRA within 6 months of the TAA-related loss of coverage . COBRA coverage elected during the second election period generally begins on the first day of that period. For more information on the Trade Act, visit dol.gov/agencies/eta/tradeact .

Continuation Insurance Benefits

The continuation coverage must be the same coverage currently available to similarly situated active employees and their families. (This is usually the same coverage you had before the qualifying event.) You must have the same benefits, options, and services currently available to participants or beneficiaries similar to you under the plan, such as the right to choose optional coverage options during the open enrollment period. You will also be subject to the same rules and restrictions that apply to participants or beneficiaries similar to you, such as copayment requirements, deductibles, and coverage limitations. You will also be subject to the plan’s rules for applying for benefits and appealing any denials.

Any changes to plan terms that apply to similarly situated active employees and their dependents will also apply to eligible beneficiaries participating in COBRA continuation coverage. If you have or adopt a child during the period of continuation coverage, your child will automatically be considered an eligible beneficiary participating in continuation coverage. The plan must allow your child to be added to the continuation coverage.

Duration of continuation insurance

Maximum period

COBRA requires that continuation coverage be provided for a period of either 18 or 36 months from the date of the qualifying event. The length of time that continuation coverage is provided (the “maximum period” of continuation coverage) depends on the type of qualifying event. However, a plan may provide coverage for a longer period than the maximum period required by law.

When the qualifying event is the termination of employment (for reasons other than gross misconduct) or reduction in hours of employment of a covered employee, the eligible beneficiary is always eligible for 118 months of continuation coverage.

When the qualifying event is a covered employee’s termination (for reasons other than gross misconduct) or reduction in hours, and the employee was eligible for health insurance for less than 18 months before the qualifying event, the employee’s spouse and dependents may be covered under COBRA for up to 36 months from the date the employee became eligible for health insurance. For example, if the covered employee became eligible for health insurance eight months before the employee’s termination (which was a COBRA qualifying event), the employee’s spouse and children may be covered under COBRA for up to 28 months (36 months minus eight months) .

For all other qualifying events, the eligible beneficiary must obtain 36 months of continuation coverage. ⁽¹⁾

Early Termination

A group medical plan may terminate continuation coverage before the end of the maximum period for any of the following reasons:

Failure to pay insurance premiums in full and on time;
The employer no longer maintains any group health plan;
The eligible beneficiary is covered under another group health plan after electing continuation coverage;
The eligible beneficiary becomes eligible for health insurance benefits upon election of continuation coverage; or
A qualified beneficiary has engaged in fraud or other conduct that could justify the termination of coverage for a similarly situated participant or beneficiary without obtaining continued coverage.

If continuation coverage is terminated early, the plan must send a notice of early termination to eligible beneficiaries. ( “ COBRA Notice and Election Procedures” .)

If you decide to end your COBRA coverage early, you generally cannot enroll in Marketplace coverage outside of the open enrollment period ( ” Alternatives to COBRA Continuation Coverage” ).

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Extend the renewal period by 18 months

An individual who is entitled to a maximum of 18 months of continuation coverage may be eligible for an extension of continuation coverage for a maximum of 18 months in two circumstances: the first being the occurrence of a disability of a qualified beneficiary and the second being the occurrence of a second qualifying event.

Disability

If one eligible beneficiary in your family becomes disabled and meets certain requirements, all eligible beneficiaries in the family are eligible to extend the maximum continuation coverage period by 11 months (for a total maximum of 29 months of continuation coverage). During the 11-month disability extension period, the plan may charge higher premiums to eligible beneficiaries, up to 150% of the cost of insurance.

The requirements are that the Social Security Administration (SSA) must first determine that the eligible beneficiary has become disabled within 60 days of the continuation of coverage and secondly that he or she remains disabled for the remainder of the 18-month continuation period.

Qualified disabled beneficiaries (or someone else on their behalf) must also notify the plan of SSA’s determination. A plan may set a time limit for sending a disability notice, but the time limit cannot be less than 60 days from the latest of the following dates:

The date SSA issued the disability determination;
The date on which the qualifying event occurred;
The date on which the eligible beneficiary loses (or is about to lose) plan coverage due to a qualifying event; or
Eligible beneficiaries are notified of their plan notification responsibilities and notification procedures through the SPD or COBRA general notice.

If the SSA determines that the eligible beneficiary is no longer disabled, the right to the extended disability period ends. The plan may require the eligible disabled beneficiary to send a notice after the determination is made. The plan must allow the eligible disabled beneficiary at least 30 days from the date the SSA announces the determination to send the notice.

The plan should provide in the SPD (and any notice of election providing for an 18-month continuation period) how notice of disability and of cessation of disability will be given.

Second Qualifying Event

The maximum 18-month continuation coverage period for an eligible beneficiary (for a total maximum of 36 months of continuation coverage) may be extended by an additional 18 months if the eligible beneficiary experiences a second qualifying event, such as death of a covered employee, divorce or legal separation of a covered employee and spouse, entitlement to Medicare (under certain circumstances), or loss of dependent child status under the plan. An event qualifies as a second qualifying event only if, in the absence of the first qualifying event, it would cause the eligible beneficiary to lose coverage under the plan.

If a second qualifying event occurs, you need to notify the plan. The plan’s SPD (and any election notice providing for an 18-month continuation period) should provide for the sending of the second qualifying event notice. The plan may set a time limit for sending the notice, but the time limit cannot be less than 60 days from the latest of the following dates:

The date on which the qualifying event occurred;
The date you lose (or would lose) coverage under the Plan due to a Qualifying Event; or
By providing an SPD or COBRA general notice, you are informed of your obligation to notify the plan and the dates of the notification procedures.

Summary of Qualifying Events, Qualifying Beneficiaries, and Maximum Period of Continuing Coverage

The chart below shows the maximum period for which continuation coverage must be provided for certain qualifying events and the eligible beneficiaries who are entitled to elect continuation coverage upon the occurrence of certain events. Note that an event is a qualifying event only if it causes the eligible beneficiary to lose coverage under the plan.

Qualifying Events	Eligible Beneficiary	Maximum duration of continuation insurance
Termination of employment (other than for serious misconduct) or reduction of working hours	Employee’s spouse and dependent children	18 months ^( 2⁾
Employees participate in medical insurance	Spouse’s dependent children	36 months ⁽3⁾
Divorce or Legal Separation	Spouse’s dependent children	36 months
Death of an employee	Spouse’s dependent children	36 months
“Loss of planned “dependent child” status	Dependent children	36 months

Paying continuation insurance premiums

Your group health plan can ask you to pay for the cost of COBRA continuation coverage. The maximum amount charged to a qualified beneficiary cannot exceed 102% of the cost to a similarly situated covered person under the plan who had not had a qualifying event. When calculating COBRA premiums, plans can include both employee and employer contributions, plus an additional 2% for administrative expenses.

For eligible beneficiaries who receive the 11-month extension of disability continuation coverage, premiums for this extension period will increase to 150% of the total plan premium.

A plan can increase COBRA premiums for eligible beneficiaries if the cost of the plan increases , but generally, the plan must determine the premiums before each 12-month premium cycle. If you request, the plan must allow you to pay the required premium monthly, and may also allow you to pay at other intervals (e.g., weekly or quarterly). The COBRA election notice should describe all necessary information about COBRA premiums, when they are due, and the consequences of late payment and nonpayment.

Plans cannot require you to pay your premiums immediately after you make a COBRA election. Plans must allow you at least 45 days to complete your initial premium payment after you elect COBRA (in other words, the day you mail the election form if you mail it by regular mail). If you fail to complete any payment within the initial 45-day period, the plan can terminate your COBRA rights. Plans should set due dates for any premiums for subsequent periods of coverage, but each payment should have a grace period of at least 30 days.

If you do not pay your premium on the first day of your coverage period, but during the grace period, your coverage may be canceled until payment is received and then reinstated retroactively to the date your coverage period began. If full payment is not received during the grace period, the plan may terminate your coverage.

If the payment amount is incorrect but not significantly less than the amount due, the plan must notify you of the difference and give you a reasonable period (30 days is considered reasonable for this purpose) to pay the difference. Plans are not obligated to send monthly premium payment notices, but if the plan terminates your continuation coverage because you did not make timely payments, the plan must provide notice of early termination.

As part of a separation agreement, some employers may subsidize or pay for the entire health insurance coverage, including the termination of COBRA coverage for the employee and his or her dependents. If you are receiving this type of benefit, discuss with your plan administrator how this may affect your COBRA coverage or your special enrollment rights.

If you have any questions about the Health Insurance Tax Credit, visit IRS.gov/hctc .

Coordination with other federal benefit laws

The Family and Medical Leave Act ( FMLA ) requires employers to maintain any “group health insurance” for employees on family and medical leave on the same terms and conditions as if the employee continued to work. Employees may choose not to maintain group health plan coverage during FMLA leave. However, when the employee returns from leave, the employee is entitled to resume coverage, including coverage for family or dependents, under the same terms as before the leave, without any qualification period, medical examination, exclusion of pre-existing conditions, etc.

Group health insurance provided under the FMLA during family or medical leave is not a continuation of COBRA coverage, and leave under the Act is not a COBRA qualifying event. However, a COBRA qualifying event may occur when an employer ceases to meet its obligations for health benefits under the FMLA , such as when an employee who is on FMLA decides not to return to work and notifies the employer that they do not intend to return.

The Affordable Care Act provides additional protections for coverage under employment-based group health plans, including COBRA continuation coverage. These protections include:

Extending insurance coverage for dependent children up to age 26,
Prohibit coverage limitations or exclusions based on pre-existing conditions,
Prohibit lifetime or annual monetary limits on essential health benefits, and
Require group health plans and insurers to provide easily understandable summaries of health plan benefits and coverage.

Additional coverage available through your employer’s insurance plan includes:

Some preventive services with no cost-sharing (such as blood pressure, diabetes, and cholesterol testing, regular well-baby and well-child visits, routine vaccinations, and many cancer screenings); and
You don’t need your health plan’s prior approval to go to a hospital emergency department for emergency services that is not in your plan’s network.

The federal government’s role

COBRA continuation laws are administered by several agencies. The Departments of Labor and Treasury have jurisdiction over private sector group health plans. The Department of Health and Human Services administers continuation laws that apply to state and local government health plans.

The Department of Labor’s interpretive responsibilities for COBRA are limited to COBRA ‘s disclosure and notification requirements. The Department of Labor has issued regulations regarding COBRA ‘s notification requirements. The Treasury Department has interpretive responsibilities to define required continuation coverage. The Treasury Department’s Internal Revenue Service has issued regulations regarding COBRA ‘s eligibility, coverage, and payment requirements. The Department of Labor and the Treasury Department share jurisdiction over the enforcement of these provisions.