COBRA
COBRA administration looks straightforward on paper: an employee has a qualifying event, you send a notice, they elect coverage or they don't. In practice, it's one of the more unforgiving corners of benefits compliance. The timelines are strict, the notice requirements are specific, and the penalties for getting it wrong can add up fast, even when the mistake was completely unintentional.
The good news is that most COBRA missteps fall into a handful of predictable categories. Once you know where employers typically go wrong, it's much easier to build a process that avoids those pitfalls altogether.
Here are five of the most common COBRA mistakes, and what to do instead.
“Mini-COBRA” is a term commonly used for states that have passed a law to require continuation of coverage rights for group insurance plans that are regulated by the state. Most commonly, Mini-COBRA applies to fully insured medical plans and Health Maintenance Organizations (HMOs). A handful of states also extend continuation of coverage rights to fully insured dental and/or vision plans, and one state (Minnesota) extends continuation of coverage rights to group term life insurance.
Shortly after the COVID-19 national emergency was declared in 2020, the Department of Labor (DOL) issued guidance allowing for additional time for participants to make COBRA elections and premium payments and to exercise their HIPAA special enrollment rights, among other things. Employers, administrators, and insurers are to disregard a period of time referred to as the “Outbreak Period.” The Outbreak Period will end 60 days after the COVID-19 national emergency ends.
The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires employers with 20 or more employees to offer continuation coverage under a group health plan for periods of 18, 29 or 36 months depending on the qualifying event. Qualifying events generally include a loss of coverage due to 1) termination of employment, 2) a reduction in hours, 3) an employee’s entitlement to Medicare, 4) death of the employee, 5) divorce or legal separation from the employee, and 6) a dependent child reaching the maximum age limit to be covered under the plan.
The COVID-19 national public health emergency is set to expire on January 11, 2023; however, the Biden administration is expected to issue another extension of the national public health emergency. It is unknown at this time when the national public health emergency will be declared over.
The COVID-19 national emergency was set to expire on July 15, 2022; however, a 90-day extension of the national emergency was issued, and the national emergency is now set to expire on October 13, 2022 (absent another extension).
On May 18, 2021, the Internal Revenue Service (IRS) issued Notice 2021-31 with additional guidance pertaining to the COBRA subsidies authorized under the American Rescue Plan Act of 2021 (“ARPA”). The guidance is broken up into various sections and consists of 86 different frequently asked questions (FAQs). Some details summarizing the guidance has been provided below.
The U.S. Department of Health and Human Services (HHS) recently finalized its Notice of Benefit and Payment Parameters which is also summarized in this Fact Sheet. These regulations are issued each year and make updates and changes to various provisions of the Affordable Care Act (ACA).
The Department of Labor (DOL) issued an FAQ on April 7, 2021 relative to the application of COBRA subsidies authorized under the American Rescue Plan Act of 2021 (ARPA). The information below summarizes the content of the FAQ.
Model Notices
The DOL has provided the following model notices:
On March 11, 2021, President Joseph Biden signed into law the American Rescue Plan Act (ARPA). ARPA is the third stimulus package signed into law in response to the COVID-19 pandemic. Under ARPA, two significant provisions were included that will help more Americans obtain and pay for health insurance coverage.
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