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COBRA and Health Insurance (Read This Article
Before It)
Congress
passed the landmark Consolidated Omnibus Budget Reconciliation Act
(COBRA) health benefit provisions in 1986. The law amends the Employee
Retirement Income Security Act (ERISA), the Internal Revenue Code,
and the Public Health Service Act to require most group health plans
to provide a temporary continuation of group health coverage that
otherwise might be terminated.
COBRA requires continuation coverage to be offered to covered employees,
their spouses, their former spouses, and their dependent children
when group health coverage would otherwise be lost due to certain
specific events. Those events include the death of a covered employee,
termination or reduction in the hours of a covered employees employment
for reasons other than gross misconduct, divorce, or legal separation
from a covered employee, a covered employees becoming entitled to
Medicare, and a childs loss of dependent status (and therefore coverage)
under the plan.
Employers may require individuals who elect continuation coverage
to pay the full cost of the coverage, plus a 2 percent administrative
charge. The required payment for continuation coverage is often more
expensive than the amount that active
employees are required to pay for group health coverage, since the
employer usually pays part of the cost of employees coverage and all
of that cost can be charged to the individuals receiving continuation
coverage.
While COBRA continuation coverage must be offered, it lasts only for
a limited period of time. COBRA generally applies to all group health
plans maintained by private-sector employers (with at least 20 employees)
or by state and local governments. The law does not apply, however,
to plans sponsored by the Federal government or by churches and certain
church-related organizations.
Under COBRA, a group health plan is any arrangement that an employer
establishes or maintains to provide employees or their families with
medical care, whether it is provided through insurance, by a health
maintenance organization, out of the employers assets on a pay-as-you-go
basis, or otherwise. a Medical career for this purpose includes: inpatient
and outpatient hospital care, physician care, surgery and other major
medical benefits, prescription drugs, dental and vision care.
Life insurance is not considered a medical care,are not are disability
benefits; and COBRA does not cover plans that provide only life insurance
or disability benefits. Group health plans covered by COBRA that are
sponsored by private sector employers generally are governed by ERISA.
ERISA does not require employers to establish plans or to provide
any particular type or level of benefits, but it does require plans
to comply with ERISA's rules, and ERISA gives participants and beneficiaries
rights that are enforceable in court. (Author)
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