Lawyer Listings Add, Update, or Remove Listings

COBRA Continuation Coverage

The federal right to stay on an employer's group health plan after leaving the job, losing hours, divorcing, or a covered employee's death - at the full premium, for a limited period, if elected in time.

Informational only - this is not legal advice. These definitions explain general legal vocabulary in plain English. They are not advice about your situation, reading them creates no attorney-client relationship, and the law differs from state to state and changes over time. For advice you can rely on, speak to a lawyer licensed in your state.

What it means

COBRA lets a person who would otherwise lose coverage under an employer's group health plan keep the same coverage for a limited period by paying for it themselves. It applies to plans of employers above a size threshold set by the statute, and it is triggered by a "qualifying event": the covered employee leaving the job (other than for gross misconduct) or losing enough hours to lose eligibility, or - for a spouse or dependent child - the employee's death, divorce or legal separation, the employee becoming entitled to Medicare, or the child ageing out of dependent status. Each person who loses coverage, not just the employee, has their own independent right to elect.

The mechanics are deadlines and notices, and they are where rights are lost. The employer must notify the plan of the event, the plan must send an election notice, and the qualified beneficiary then has an election period, set by statute, in which to choose coverage; coverage elected late is not coverage. The cost is the full premium - the employer's share as well as the employee's - plus an administrative charge the statute permits, which is why COBRA is often more expensive than a marketplace plan. The maximum period differs by the type of event and can be extended for disability or a second event, and it ends early if the premium is not paid or the person becomes covered under another group plan.

Since the Affordable Care Act, loss of job-based coverage is itself a special enrolment event for the individual marketplace, so the decision is usually COBRA (same plan, same doctors, higher cost) against a marketplace plan (possibly subsidised, possibly a different network), and the two deadlines run at the same time. Smaller employers not covered by the federal law are often covered by a state "mini-COBRA" statute with its own terms.

Where this comes from

COBRA is the Consolidated Omnibus Budget Reconciliation Act of 1985. For private-sector plans the continuation provisions are in ERISA, 29 U.S.C. §§ 1161-1168, with a parallel excise-tax enforcement provision at 26 U.S.C. § 4980B; state and local government plans are covered by the Public Health Service Act, 42 U.S.C. § 300bb-1 and following. The Department of Labor's notice rules are at 29 C.F.R. §§ 2590.606-1 to 2590.606-4. The employer-size threshold, election period, premium ceiling and maximum coverage periods are all set in the statute and are not stated here.

When people hire a lawyer for this

A missed election notice is a claim: a plan that fails to send the notice can be liable for the medical costs the person incurred uncovered, and a statutory daily penalty may apply. That, and a denial of continuation on a disputed "gross misconduct" ground, are the two situations worth a lawyer. Everything else - which plan to choose, whether a subsidy is available - is a benefits question, and the marketplace deadline should be tracked alongside the COBRA one.

Find a lawyer for this in your state

Choose your state. Each link opens the directory page for the city in that state with the most currently published law firms in this practice area; a +n beside the city is how many other cities in the state also have one. The list is generated when this page loads, so a state whose listings have lapsed drops out rather than becoming a dead link.

« All glossary terms

Part of the LawyerLand plain-English legal glossary. Definitions are written from primary sources - statutes and court rules - and each entry states the authority it rests on, or says plainly when the doctrine is state law with no national rule.

If you cannot afford a lawyer, civil legal aid programmes provide free help with many of these problems: civil legal aid programmes by state.

Related free reference tools: statute of limitations for a personal-injury claim, by state, quoted from each state's official text - part of LawyerLand's legal reference tools.