FAQs on COBRA ContinuationHealth Coverage for WorkersU. S. Department of LaborEmployee Benefits Security AdministrationQ1:What is COBRA continuation health coverage?The Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions amend theEmployee Retirement Income Security Act, the Internal Revenue Code and the Public Health ServiceAct to require group health plans to provide a temporary continuation of group health coverage thatotherwise might be terminated.Q2:What does COBRA do?COBRA requires continuation coverage to be offered to covered employees, their spouses, formerspouses, and dependent children when group health coverage would otherwise be lost due to certainspecific events. COBRA continuation coverage is often more expensive than the amount that activeemployees are required to pay for group health coverage, since the employer usually pays part of thecost of employees' coverage and all of that cost can be charged to individuals receiving continuationcoverage.Q3:What group health plans are subject to COBRA?The law generally applies to all group health plans maintained by private-sector employers with 20or more employees, or by state or local governments. The law does not apply to plans sponsoredby the Federal Government or by churches and certain church-related organizations. In addition,many states have laws similar to COBRA, including those that apply to health insurers ofemployers with less than 20 employees (sometimes called mini-COBRA). Check with your stateinsurance commissioner's office to see if such coverage is available to you.Q4:Are there alternatives for health coverage other than COBRA?If you become entitled to elect COBRA continuation coverage when you otherwise would lose grouphealth coverage under a group health plan, you should consider all options you may have to get otherhealth coverage before you make your decision. There may be more affordable or more generouscoverage options for you and your family through other group health plan coverage (such as a spouse'splan), the Health Insurance Marketplace, or Medicaid.Under the Health Insurance Portability and Accountability Act (HIPAA), if you or your dependentsare losing eligibility for group health coverage, including eligibility for continuation coverage, youmay have a right to special enroll (enroll without waiting until the next open season for enrollment) inother group health coverage. For example, an employee losing eligibility for group health coveragemay be able to special enroll in a spouse's plan. A dependent losing eligibility for group healthcoverage may be able to enroll in a different parent's group health plan. To have a special enrollmentopportunity, you or your dependent must have had other health coverage when you previously

2declined coverage in the plan in which you now want to enroll. You must request special enrollmentwithin 30 days from the loss of your job-based coverage.Losing your job-based coverage is also a special enrollment event in the Health InsuranceMarketplace (Marketplace). The Marketplace offers "one-stop shopping" to find and compareprivate health insurance options. In the Marketplace, you could be eligible for a tax credit thatlowers your monthly premiums and cost-sharing reductions (amounts that lower your out-ofpocket costs for deductibles, coinsurance and copayments), and you can see what your premium,deductibles, and out-of-pocket costs will be before you make a decision to enroll.Eligibility for COBRA continuation coverage won't limit your eligibility for Marketplace coverage orfor a tax credit. You can apply for Marketplace coverage at or by calling 1-800-3182596 (TTY 1-855-889-4325). To qualify for special enrollment in a Marketplace plan, you must select aplan within 60 days before or 60 days after losing your job-based coverage. In addition, during anopen enrollment period, anyone can enroll in Marketplace coverage. If you need health coverage inthe time between losing your job-based coverage and beginning coverage through the Marketplace (forexample, if you or a family member needs medical care), you may wish to elect COBRA coverage fromyour former employer's plan. COBRA continuation coverage will ensure you have health coverageuntil the coverage through your Marketplace plan begins.Through the Marketplace you can also learn if you qualify for free or low-cost coverage fromMedicaid or the Children's Health Insurance Program (CHIP). You can apply for and enroll inMedicaid or CHIP any time of year. If you qualify, your coverage begins immediately. or call 1-800-318-2596 (TTY 1-855-889-4325) for more information or to apply for theseprograms. You can also apply for Medicaid by contacting your state Medicaid office and learn moreabout the CHIP program in your state by calling 1-877-KIDS-NOW (543-7669) or you or your dependent elects COBRA continuation coverage, you will have another opportunity torequest special enrollment in a group health plan or a Marketplace plan if you have a new specialenrollment event, such as marriage, the birth of a child, or if you exhaust your continuation coverage.To exhaust COBRA continuation coverage, you or your dependent must receive the maximum periodof continuation coverage available without early termination. Keep in mind if you choose to terminateyour COBRA continuation coverage early with no special enrollment opportunity at that time, yougenerally will have to wait to enroll in other coverage until the next open enrollment period for thenew group health plan or the Marketplace.Q5:Who is entitled to continuation coverage under COBRA?In order to be entitled to elect COBRA continuation coverage, your group health plan must be coveredby COBRA; a qualifying event must occur; and you must be a qualified beneficiary for that event.Plan Coverage - COBRA covers group health plans sponsored by an employer (private-sector orstate/local government) that employed at least 20 employees on more than 50 percent of its typicalbusiness days in the previous calendar year. Both full- and part-time employees are counted todetermine whether a plan is subject to COBRA. Each part-time employee counts as a fraction of a fulltime employee, with the fraction equal to the number of hours that the part-time employee workeddivided by the hours an employee must work to be considered full time.

3Qualifying Events - Qualifying events are events that cause an individual to lose his or her grouphealth coverage. The type of qualifying event determines who the qualified beneficiaries are for thatevent and the period of time that a plan must offer continuation coverage. COBRA establishes onlythe minimum requirements for continuation coverage. A plan may always choose to provide longerperiods of continuation coverage.The following are qualifying events for covered employees if they cause the covered employee to losecoverage: Termination of the employee's employment for any reason other than gross misconduct; orReduction in the number of hours of employment.The following are qualifying events for the spouse and dependent child of a covered employee if theycause the spouse or dependent child to lose coverage: Termination of the covered employee's employment for any reason other than gross misconduct;Reduction in the hours worked by the covered employee;Covered employee becomes entitled to Medicare;Divorce or legal separation of the spouse from the covered employee; orDeath of the covered employee.In addition to the above, the following is a qualifying event for a dependent child of a coveredemployee if it causes the child to lose coverage: Loss of dependent child status under the plan rules. Under the Affordable Care Act, plans thatoffer coverage to children on their parents' plan must make the coverage available until theadult child reaches the age of 26.Qualified Beneficiaries - A qualified beneficiary is an individual covered by a group health plan on theday before a qualifying event occurred that caused him or her to lose coverage. Only certain individualscan become qualified beneficiaries due to a qualifying event, and the type of qualifying eventdetermines who can become a qualified beneficiary when it happens. A qualified beneficiary must be acovered employee, the employee's spouse or former spouse, or the employee's dependent child. Incertain cases involving the bankruptcy of the employer sponsoring the plan, a retired employee, theretired employee's spouse or former spouse, and the retired employee's dependent children may bequalified beneficiaries. In addition, any child born to or placed for adoption with a covered employeeduring a period of continuation coverage is automatically considered a qualified beneficiary. Anemployer's agents, independent contractors, and directors who participate in the group health plan mayalso be qualified beneficiaries.Q6:How do I become eligible for COBRA continuation coverage?To be eligible for COBRA coverage, you must have been enrolled in your employer's health plan whenyou worked and the health plan must continue to be in effect for active employees. COBRAcontinuation coverage is available upon the occurrence of a qualifying event that would, except for theCOBRA continuation coverage, cause an individual to lose his or her health care coverage.

Q7:4How do I find out about COBRA coverage?Group health plans must provide covered employees and their families with certain notices explainingtheir COBRA rights. Your COBRA rights must be described in the plan's Summary Plan Description(SPD), which you should receive within 90 days after you first become a participant in the plan. Inaddition, group health plans must give each employee and spouse who becomes covered under the plana general notice describing COBRA rights, also provided within the first 90 days of coverage.Before a group health plan must offer continuation coverage, a qualifying event must occur, and theplan must be notified of the qualifying event. Who must give notice of the qualifying event dependson the type of qualifying event.The employer must notify the plan if the qualifying event is the covered employee's termination orreduction of hours of employment, death, entitlement to Medicare, or bankruptcy of a private-sectoremployer. The employer must notify the plan within 30 days of the event.You (the covered employee or one of the qualified beneficiaries) must notify the plan if the qualifyingevent is divorce, legal separation, or a child's loss of dependent status under the plan. The plan musthave procedures for how to give notice of the qualifying event, and the procedures should be describedin both the general notice and the plan's SPD. The plan can set a time limit for providing this notice, butit cannot be shorter than 60 days, starting from the latest of: (1) the date on which the qualifying eventoccurs; (2) the date on which you lose (or would lose) coverage under the plan due to the qualifyingevent; or (3) the date on which you are informed, through the furnishing of either the SPD or theCOBRA general notice, of the responsibility to notify the plan and procedures for doing so.If your plan does not have reasonable procedures for how to give notice of a qualifying event, you cangive notice by contacting the person or unit that handles your employer's employee benefits matters.If your plan is a multiemployer plan, notice can also be given to the joint board of trustees, and, if theplan is administered by an insurance company (or the benefits are provided through insurance), noticecan be given to the insurance company.When the plan receives a notice of a qualifying event, it must give the qualified beneficiaries an electionnotice which describes their rights to continuation coverage and how to make an election. This noticemust be provided within 14 days after the plan receives notice of the qualifying event.Q8:How long do I have to elect COBRA coverage?If you are entitled to elect COBRA coverage, you must be given an election period of at least 60 days(starting on the later of the date you are furnished the election notice or the date you would losecoverage) to choose whether or not to elect continuation coverage.Each of the qualified beneficiaries for a qualifying event may independently elect COBRA coverage.This means that if both you and your spouse are entitled to elect continuation coverage, you each maydecide separately whether to do so. The covered employee or spouse must be allowed to elect on behalfof any dependent children or on behalf of all of the qualified beneficiaries. A parent or legal guardianmay elect on behalf of a minor child.

Q9:5If I waive COBRA coverage during the election period, can I still get coverage at alater date?If you waive COBRA coverage during the election period, you must be permitted later to revoke yourwaiver of coverage and to elect continuation coverage as long as you do so during the election period.Then, the plan need only provide continuation coverage beginning on the date you revoke the waiver.In addition, certain Trade Adjustment Assistance (TAA) Program participants have a secondopportunity to elect COBRA continuation coverage. Individuals who are eligible and receive TradeReadjustment Allowances (TRA), individuals who would be eligible to receive TRA, but have not yetexhausted their unemployment insurance (UI) benefits, and individuals receiving benefits underAlternative Trade Adjustment Assistance (ATAA) or Reemployment Trade Adjustment Assistance(RTAA), and who did not elect COBRA during the general election period, may get a second electionperiod. This additional, second election period is measured 60 days from the first day of the month inwhich an individual is determined eligible for the TAA benefits listed above and receives such benefit.For example, if an individual’s general election period runs out and he or she is determined eligible forTRA (or would be eligible for TRA but have not exhausted UI benefits) or begin to receive ATAA orRTAA benefits 61 days after separating from employment, at the beginning of the month, he or shewould have approximately 60 more days to elect COBRA. However, if this same individual does notmeet the eligibility criteria until the end of the month, the 60 days are still measured from the first ofthe month, in effect giving the individual about 30 days. Additionally, a COBRA election must bemade not later than 6 months after the date of the TAA-related loss of coverage. COBRA coveragechosen during the second election period typically begins on the first day of that period. Moreinformation about the Trade Act is available at Under COBRA, what benefits must be covered?If you elect continuation coverage, the coverage you are given must be identical to the coveragecurrently available under the plan to similarly situated active employees and their families (generally,this is the same coverage that you had immediately before the qualifying event). You will also beentitled, while receiving continuation coverage, to the same benefits, choices, and services that asimilarly situated participant or beneficiary is currently receiving under the plan, such as the rightduring open enrollment season to choose among available coverage options. You will also be subject tothe same rules and limits that would apply to a similarly situated participant or beneficiary, such as copayment requirements, deductibles, and coverage limits. The plan's rules for filing benefit claims andappealing any claims denials also apply.Any change made to the plan's terms that apply to similarly situated active employees and their familieswill also apply to qualified beneficiaries receiving COBRA continuation coverage. If a child is born to oradopted by a covered employee during a period of continuation coverage, the child is automaticallyconsidered to be a qualified beneficiary receiving continuation coverage. You should consult your planfor the rules that apply for adding your child to continuation coverage under those circumstances.Q11: How long does COBRA coverage last?COBRA requires that continuation coverage extend from the date of the qualifying event for a limitedperiod of 18 or 36 months. The length of time depends on the type of qualifying event that gave rise to

6the COBRA rights. A plan, however, may provide longer periods of coverage beyond the maximumperiod required by law.When the qualifying event is the covered employee's termination of employment or reduction in hoursof employment, qualified beneficiaries are entitled to 18 months of continuation coverage.When the qualifying event is the end of employment or reduction of the employee's hours, and theemployee became entitled to Medicare less than 18 months before the qualifying event, COBRAcoverage for the employee's spouse and dependents can last until 36 months after the date the employeebecomes entitled to Medicare. For example, if a covered employee becomes entitled to Medicare 8months before the date his/her employment ends (termination of employment is the COBRA qualifyingevent), COBRA coverage for his/her spouse and children would last 28 months (36 months minus 8months). For more information on how entitlement to Medicare impacts the length of COBRA coverage,contact the Department of Labor's Employee Benefits Security Administration at or bycalling 1-866-444-3272.For other qualifying events, qualified beneficiaries must be provided 36 months of continuationcoverage.Q12: Can continuation coverage be terminated early for any reason?A group health plan may terminate coverage earlier than the end of the maximum period for any ofthe following reasons: Premiums are not paid in full on a timely basis;The employer ceases to maintain any group health plan;A qualified beneficiary begins coverage under another group health plan after electingcontinuation coverage;A qualified beneficiary becomes entitled to Medicare benefits after electing continuationcoverage; orA qualified beneficiary engages in conduct that would justify the plan in terminatingcoverage of a similarly situated participant or beneficiary not receiving continuationcoverage (such as fraud).If continuation coverage is terminated early, the plan must provide the qualified beneficiary with anearly termination notice. The notice must be given as soon as practicable after the decision is made, andit must describe the date coverage will terminate, the reason for termination, and any rights the qualifiedbeneficiary may have under the plan or applicable law to elect alternative group or individual coverage.If you decide to terminate your COBRA coverage early, you generally won't be able to get a Marketplaceplan outside of the open enrollment period. For more information on alternatives to COBRA coverage,see question 4 above.Q13: Can I extend my COBRA continuation coverage?If you are entitled to an 18 month maximum period of continuation coverage, you may become eligiblefor an extension of the maximum time period in two circumstances. The first is when a qualifiedbeneficiary is disabled; the second is when a second qualifying event occurs.

7Disability - If any one of the qualified beneficiaries in your family is disabled and meets certainrequirements, all of the qualified beneficiaries receiving continuation coverage due to a singlequalifying event are entitled to an 11-month extension of the maximum period of continuationcoverage (for a total maximum period of 29 months of continuation coverage). The plan can chargequalified beneficiaries an increased premium, up to 150 percent of the cost of coverage, during the 11month disability extension.The requirements are:1. that the Social Security Administration (SSA) determines that the disabled qualifiedbeneficiary is disabled before the 60th day of continuation coverage; and2. that the disability continues during the rest of the 18-month period of continuation coverage.The disabled qualified beneficiary or another person on his or her behalf also must notify the plan of theSSA determination. The plan can set a time limit for providing this notice of disability, but the timelimit cannot be shorter than 60 days, starting from the latest of: (1) the date on which SSA issues thedisability determination; (2) the date on which the qualifying event occurs; (3) the date on which thequalified beneficiary loses (or would lose) coverage under the plan as a result of the qualifying event; or(4) the date on which the qualified beneficiary is informed, through the furnishing of the SPD or theCOBRA general notice, of the responsibility to notify the plan and the procedures for doing so.The right to the disability extension may be terminated if the SSA determines that the disabledqualified beneficiary is no longer disabled. The plan can require qualified beneficiaries receiving thedisability extension to notify it if the SSA makes such a determination, although the plan must give thequalified beneficiaries at least 30 days after the SSA determination to do so.The rules for how to give a disability notice and a notice of no longer being disabled should be describedin the plan's SPD (and in the election notice if you are offered an 18-month maximum period ofcontinuation coverage).Second Qualifying Event - If you are receiving an 18-month maximum period of continuation coverage,you may become entitled to an 18-month extension (giving a total maximum period of 36 months ofcontinuation coverage) if you experience a second qualifying event that is the death of a coveredemployee, the divorce or legal separation of a covered employee and spouse, a covered employee'sbecoming entitled to Medicare (in certain circumstances), or a loss of dependent child status under theplan. The second event can be a second qualifying event only if it would have caused you to losecoverage under the plan in the absence of the first qualifying event. If a second qualifying event occurs,you will need to notify the plan.The rules for how to give notice of a second qualifying event should be described in the plan's SPD (andin the election notice if you are offered an 18-month maximum period of continuation coverage). Theplan can set a time limit for providing this notice, but the time limit cannot be shorter than 60 days fromthe latest of: (1) the date on which the qualifying event occurs; (2) the date on which you lose (or wouldlose) coverage under the plan as a result of the qualifying event; or (3) the date on which you areinformed, through the furnishing of either the SPD or the COBRA general notice, of the responsibility tonotify the plan and the procedures for doing so.

8Q14: Is a divorced spouse entitled to COBRA coverage from their former spouses'group health plan?Under COBRA, participants, covered spouses and dependent children may continue their plan coveragefor a limited time when they would otherwise lose coverage due to a particular event, such as divorce(or legal separation). A covered employee's spouse who would lose coverage due to a divorce may electcontinuation coverage under the plan for a maximum of 36 months. A qualified beneficiary must notifythe plan administrator of a qualifying event within 60 days after divorce or legal separation. After beingnotified of a divorce, the plan administrator must give notice, generally within 14 days, to the qualifiedbeneficiary of the right to elect COBRA continuation coverage.Q15: Who pays for COBRA coverage?Your group health plan can require you to pay for COBRA continuation coverage. The amount chargedto qualified beneficiaries cannot exceed 102 percent of the cost to the plan for similarly situatedindividuals covered under the plan who have not incurred a qualifying event. In determining COBRApremiums, the plan can include the costs paid by employees and the employer, plus an additional 2percent for administrative costs.For qualified beneficiaries receiving the 11-month disability extension, the COBRA premium forthose additional months may be increased to 150 percent of the plan's total cost of coverage forsimilarly situated individuals.COBRA charges to qualified beneficiaries may be increased if the cost to the plan increases butgenerally must be fixed in advance of each 12-month premium cycle. The plan must allow you to paythe required premiums on a monthly basis if you ask to do so, and the plan may allow you to makepayments at other intervals (for example, weekly or quarterly). The election notice should contain allof the information you need to understand the COBRA premiums you will have to pay, when they aredue, and the consequences of late payment or nonpayment.When you elect continuation coverage, you cannot be required to send any payment with your electionform. You can be required, however, to make an initial premium payment within 45 days after thedate of your COBRA election (that is the date you mail in your election form, if you use first-classmail). Failure to make any payment within that period of time could cause you to lose all COBRArights. The plan can set premium due dates for successive periods of coverage (after your initialpayment), but it must give you the option to make monthly payments, and it must give you a 30-daygrace period for payment of any premium.You should be aware that if you do not pay a premium by the first day of a period of coverage, but paythe premium within the grace period for that period of coverage, the plan has the option to cancel yourcoverage until payment is received and then reinstate the coverage retroactively back to the beginning ofthe period of coverage. Failure to make payment in full before the end of a grace period could causeyou to lose all COBRA rights.If the amount of a payment made to the plan is incorrect but is not significantly less than the amountdue, the plan is required to notify you of the deficiency and grant a reasonable period (for thispurpose, 30 days is considered reasonable) to pay the difference. The plan is not obligated to sendmonthly premium notices.

9Some employers may subsidize or pay the entire cost of health coverage, including COBRA coverage,for terminating employees and their families as part of a severance agreement. If you are receiving thistype of severance benefit, talk to your plan administrator about how this impacts your COBRAcoverage or your special enrollment rights.Q16: What is the Health Coverage Tax Credit and can it help me pay for COBRA?Certain individuals may be eligible for a refundable Federal income tax credit that can help withqualified monthly premium payments. The Health Coverage Tax Credit (HCTC), while available, maybe used to pay for specified types of health insurance coverage (including COBRA continuationcoverage).Those potentially eligible for the HCTC include workers who lose their jobs due to the negative effectsof global trade and who are eligible to receive certain benefits under the Trade Adjustment Assistance(TAA) Program, as well as certain individuals who are receiving pension payments from the PensionBenefit Guaranty Corporation (PBGC). The HCTC pays 72.5 percent of qualified health insurancepremiums, with individuals paying 27.5 percent. For more information on TAA, who are eligible for the HCTC may claim the tax credit on their income tax returns at theend of the year. The tax credit also may be available as an advance monthly payment beginning in2017. Qualified family members of eligible TAA recipients or PBGC payees who enroll in Medicare,pass away, or finalize a divorce, are eligible to receive the HCTC for up to 24 months from the monthof the event. Individuals with questions about the Health Coverage Tax Credit should visit If I did not make the premium payment on time and my coverage was canceledwhat can I do?You may want to contact your plan and ask if they will reinstate your coverage; however, if yourcoverage was terminated for not making the payment within the grace period, the plan is not requiredto reinstate your coverage. If you believe your coverage was canceled inappropriately, you cancontact an EBSA benefits advisor electronically at or call 1-866-444-3272 forassistance.Q18: How do I file a COBRA claim for benefits?Health plan rules must explain how to obtain benefits and must include written procedures forprocessing claims. You should submit a claim for benefits in accordance with these rules. Claimsprocedures must be described in the Summary Plan Description. Contact the plan administrator formore information on filing a claim for benefits.Q19: Can I receive COBRA benefits while on FMLA leave?The Family and Medical Leave Act (FMLA) requires an employer to maintain coverage under anygroup health plan for an employee on FMLA leave under the same conditions coverage would havebeen provided if the employee had continued working. Coverage provided under the FMLA is notCOBRA coverage, and taking FMLA leave is not a qualifying event under COBRA. A COBRAqualifying event may occur, however, when an employer's obligation to maintain health benefits under

10FMLA ceases, such as when an employee taking FMLA leave decides not to return to work and notifiesan employer of his or her intent not to return to work. Further information on the FMLA is availableon the Website of the U. S. Department of Labor's Wage and Hour Division at or bycalling toll-free 1-866-487-9243.Q20: I have both Medicare and COBRA coverage, how do I know which will pay mybenefits?Medicare is the Federal health insurance program for people who are 65 or older and certain youngerpeople with disabilities or End-Stage Renal Disease. If you are enrolled in Medicare as well as COBRAcontinuation coverage, there may be special coordination of benefits rules that determine whichcoverage is the primary payer of benefits. Check your Su

Loss of dependent child status under the plan rules. Under the Affordable Care Act, plans that offer coverage to children on their parents' plan must make the coverage available until the adult child reaches the age of 26. Qualified Beneficiaries - A qualified beneficiary is an individual covered by a group health plan on the