The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) generally requires group health plans sponsored by employers with 20 or more employees in the prior year to offer employees and their families the option to continue benefits for limited periods of time when coverage under the plan would otherwise end due to certain qualifying events. These events include voluntary or involuntary job loss, reduction in hours worked, death, divorce, and other life events.
COBRA sets rules for how and when continuation coverage must be offered, how employees and their families may elect COBRA, and what circumstances justify terminating coverage. The length of time for which continuation coverage must be made available depends on the type of qualifying event. For termination of employment or a reduction in hours, the maximum period of COBRA is generally 18 months. Up to 36 months of coverage may be available due to other qualifying events, or if a second qualifying event occurs during the initial period of COBRA coverage.
Please review our COBRA Steps to Success to understand the key areas involved in implementing COBRA for your company. Most states also have laws (commonly referred to as "mini-COBRA" laws) which require that group health plans provide COBRA-like continuation of benefits for certain employees and their families.
Ohio law provides employees of small companies (those with 2-19 employees) the right to continue coverage, including coverage for eligible dependents, under the current employer's group policy for up to 12 months when coverage would otherwise be lost due to termination of employment. To be eligible for continuation, the employee must have been continuously insured under the employer's group policy or similar coverage replaced by the policy, during the 3-month period ending with termination.
Continuation coverage must be provided to covered employees and eligible dependents for up to 12 months when coverage under the group policy would otherwise be lost due to involuntary termination of the covered employee's employment (other than for gross misconduct).An employee who is covered by or eligible for coverage under Medicare or any other group health care coverage is not entitled to continuation coverage.
An employee who elects to continue coverage is required to pay the employer, on a monthly basis in advance, the amount of premium contribution required by the employer. This amount may not exceed the group rate.
Continuation of benefits may be terminated before the end of 12 months for the following reasons:
Continuation coverage may also be terminated for any reason the plan would terminate coverage of an individual not receiving continuation coverage (such as fraud).
Under the federal Patient Protection and Affordable Care Act (Health Care Reform), beginning with plan years starting on or after September 23, 2010, group health plans that offer dependent coverage must make the coverage available until a child reaches the age of 26. There is a temporary exception for grandfathered group health plans, which may exclude adult children who are eligible to enroll in an employer-sponsored health plan other than the group health plan of the parent. This exception will no longer be available for plan years beginning on or after January 1, 2014.
Beginning with policies issued or renewed on or after July 1, 2010, Ohio requires insurers to offer parents with employer-sponsored health insurance the opportunity to purchase coverage for their children up to age 28 under certain conditions. For more information on the dependent coverage law, please click here. FAQs, including information on how the state and federal Affordable Care Act coverage expansions for adult children work together, are available by clicking here.
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