COBRA

Consolidated Omnibus Budget Reconciliation Act

Terminated employees or those who lose health, vision or dental plan coverage because of reduced work hours may be able to buy group coverage for themselves and their families for limited periods of time under the Consolidated Omnibus Budget Reconciliation Act (COBRA).

If you are entitled to COBRA benefits, you will receive a notice stating your right to choose to continue medical, vision and/or, dental benefits provided by the plan. You have 60 days to accept coverage or lose all rights to benefits. Once COBRA coverage is chosen, you are required to pay for the coverage.

Under COBRA, our group health plan ordinarily is defined as a plan that provides medical, vision and dental benefits for our own employees and their dependents. Benefits provided under the terms of the plan and available to COBRA beneficiaries may include:

  • Inpatient and outpatient hospital care
  • Physician care
  • Surgery and other major medical benefits
  • Prescription drugs
  • Any other medical benefits, such as dental and vision care
  • Life insurance, however, is not covered under COBRA.

 

Cobra Initial Notice

An initial general notice must be furnished to covered employees, their spouses and newly hired employees informing them of their rights under COBRA and describing provisions of the law.   Our COBRA Administrator PayFlex is responsible for sending this initial notice. 

Click here for the initial COBRA notice to identify your rights and responsibilities under the law.


Beneficiary Coverage

A qualified beneficiary generally is any individual covered by a group health plan on the day before a qualifying event. A qualified beneficiary may be an employee, the employee’s spouse and dependent children, and in certain cases, a retired employee, the retired employee’s spouse and dependent children.


Qualifying Events

"Qualifying events" are certain types of events that would cause an individual to lose health plan coverage. The type of qualifying event will determine who the qualified beneficiaries are and the required amount of time that the plan must offer the health coverage to them under COBRA. The types of qualifying events for employees are:

  • Voluntary or involuntary termination of employment for reasons other than "gross misconduct".
  • Reduction in the number of hours of employment.

The types of qualifying events for spouses are:

  • 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’s becoming entitled to Medicare
  • Divorce or legal separation of the covered employee
  • Death of the covered employee

The types of qualifying events for dependent children are the same as for the spouse with one addition:

  • Loss of "dependent child" status under the plan rules

 

NY State Continuation (mini-COBRA), after Federal COBRA is exhausted:

Due to recently enacted New York law, employees and their dependents eligible for federal COBRA coverage under fully insured products or New York State continuation coverage are eligible to be covered for a maximum of 36 months, regardless of the reason they lost coverage under the plan.   This law applies to all Pace University employees since our medical contract is issued in New York.

 Under this law, once the Federal COBRA has been exhausted, the participant and their dependents can have an additional 18 months of continuation under our group medical plan.   The additional 18 months of coverage will be covered under New York State Continuation mini-COBRA.   With regard to an employee determined to be disabled under the Social Security Act, the disabled employee may receive up to seven months of mini-COBRA after the member's federal COBRA terminates at 29 months, for a total period of up to 36 months. 

This applies for any employee or member whose qualifying event is a voluntary or involuntary termination of employment effective on COBRA on and after November 1, 2009.   If you are interested in continuing your COBRA coverage under the New York State Continuation mini-COBRA, all of the provisions outlined in the Federal COBRA notice will apply.  Please note, this extension applies only to medical coverage and not dental or vision insurance.  Dental and vision coverage will end when your Federal COBRA period is exhausted.

Periods of Federal COBRA / NY State Continuation (mini-COBRA) coverage

Qualifying Events Beneficiary Coverage
Termination Employee
Spouse
Dependent child
Total Coverage 36 Months
18 months Federal COBRA
18 months NY State mini-COBRA*
Reduced hours

Employee
Spouse
Dependent child

Total Coverage 36 Months
18 months Federal COBRA
18 months NY State mini-COBRA*
Employee entitled to Medicare Divorce or legal separation Death of covered employee
Spouse
Dependent child
36 months  Federal  COBRA
Loss of "dependent child" status Dependent child 36 months  Federal  COBRA
Extension  Due to Disability Employee
Spouse
Dependent Child
Total Coverage 36 Months
18 Months Federal COBRA ( Termination / Reduced Hours)
11 Months Federal COBRA Disability Extension
7 Months NY State Mini-COBRA*

*NY State Continuation Coverage Applies to medical only

 

How much does COBRA continuation coverage cost?

Generally, each qualified beneficiary may be required to pay the entire cost of continuation coverage.  The amount a qualified beneficiary may be required to pay may not exceed 102 percent (or, in the case of an extension of continuation coverage due to a disability, 150 percent) of the cost to the group health plan (including both employer and employee contributions) for coverage of a similarly situated plan participant or beneficiary who is not receiving continuation coverage. 


COBRA PREMIUMS:

Effective July 1, 2013 through June 30, 2014

Monthly Contributions for Dental Plan Coverage:

Dental Plan

Individual

Individual + 1

Family

CIGNA Dental PPO

$54.87

$117.69

$175.40

CIGNA Dental DHMO

$19.53

$34.86

$60.09

The above premiums exclude the 2% administrative fee.

 

Monthly contributions for Medical Plan Coverage:

Medical Plan

Individual

Individual + 1

Family

CIGNA HDHP/HSA

$722.90

$1,402.86

$2,099.44

CIGNA In-Net50

$749.90

$1,459.88

$2,183.30

CIGNA In-Net 20

$812.46

$1,581.64

$2,365.30

CIGNA 90/70

$850.24

$1,655.22

$2,475.26

CIGNA 100/70

$1,027.58

$2,000.64

$2,991.46

*The above premiums exclude the 2% administrative fee.

 

Monthly contributions for Vision Plan Coverage:

Vision Plan

Individual

Individual + 1

Family

CIGNA Vision

$5.61

$10.74

$17.41

*The above premiums exclude the 2% administrative fee.

 



 

Effective July 1, 2014 through June 30, 2015

 

Monthly Contributions for Dental Plan Coverage:

Dental Plan

Individual

Individual + 1

Family

CIGNA Dental PPO

$56.92

$122.06

$181.90

CIGNA Dental DHMO

$20.22

$36.08

$62.20

The above premiums exclude the 2% administrative fee.

 

 

Monthly contributions for Medical Plan Coverage:

Medical Plan

Individual

Individual + 1

Family

CIGNA HDHP/HSA

$757.82

$1,470.62

$2,200.84

CIGNA In-Net50

$786.12

$1,530.39

$2,288.75

CIGNA In-Net 20

$851.70

$1,658.03

$2,479.54

CIGNA 90/70

$891.31

$1,735.17

$2,594.82

CIGNA 100/70

$1,077.21

$2,097.27

$3,135.95

*The above premiums exclude the 2% administrative fee.

 

 

Monthly contributions for Vision Plan Coverage:

Vision Plan

Individual

Individual + 1

Family

CIGNA Vision

$5.61

$10.74

$17.41

*The above premiums exclude the 2% administrative fee.