​If you’re a professional in the benefits field, you’ve probably heard it all: “How hard can it be? You’re just picking a health plan, right?” The truth is benefits professionals are the unsung heroes of the workplace.

They navigate a maze of rising costs, diverse workforce needs, administrative hurdles, and the ongoing battle to get employees to care about, and understand, their benefits.

As the year winds down and open enrollment ramps up, health insurance challenges seem to multiply. But here’s a look behind the curtain at the top challenges benefits professionals face year-round—and why they deserve more credit than they often get.

We’re living in an age where the price of everything, from eggs to energy bills, is constantly climbing. ​Healthcare is no exception.  Benefits professionals are tasked with

a seemingly impossible mission: manage skyrocketing costs while keeping benefit packages attractive to employees and reasonable for the company’s budget.

Why it’s a big deal:
Competitive benefits play a major role in attracting and retaining top talent. But finding that sweet spot—where the benefits are robust, yet affordable—is like juggling flaming swords. Managing the challenges requires deep knowledge of the health insurance market, an understanding of employee priorities, and some serious negotiation skills with insurance carriers.

What’s at stake? Offer too little, and employees will head for greener pastures but spend too much, and the company’s bottom line takes a hit.

The result? Benefits professionals spend hours analyzing coverage details, comparing plans, and ensuring they’re worth the cost. It’s not just about numbers; it’s about finding value.

Let’s face it—there’s no such thing as a one-size-fits-all benefits plan. Employees come from different backgrounds, are in different life stages, and have unique healthcare needs. A single company might employ everyone from fresh college grads to nearing-retirement boomers, and benefits professionals are responsible for addressing all those needs.

Why it’s tricky:

• Younger employees might prioritize student loan assistance or wellness programs.
• Mid-career professionals might focus on comprehensive healthcare or family leave.
• Older employees might want robust retirement benefits and long-term care options.

The challenge? 

• Benefits professionals need to craft packages that check as many boxes as possible without overcomplicating the offerings. It’s about balancing flexibility with feasibility, which can feel like walking a tightrope blindfolded.

The Admin Avalanche

Beneath the surface of those glossy open enrollment emails and neatly organized benefits portals lies a mountain of administrative tasks that benefits professionals climb daily.

What they’re juggling:

• Processing enrollments and terminations for new hires and departing employees.
• Handling errors like lost coverage or incorrect deductions.
• Navigating endless questions from employees, carriers, and everyone in between.

Why it’s challenging:

• Benefits professionals are essentially the “fix-it” team for every issue under the sun. An employee’s coverage unexpectedly disappears? They’re on it. The insurance carrier made an error? They’ll sort it out. Someone doesn’t understand what an HSA is? Time for an impromptu benefits 101 session.

The kicker:

• This all happens while they’re also planning open enrollment, evaluating new vendors, and keeping up with compliance changes. To say they’re multitasking is an understatement.

Employee Engagement: The Struggle Is Real

Here’s a question: How many employees can confidently explain their benefits package? If your guess is “not many,” you’re not alone.

The disconnect –  Employees often view benefits as something to deal with once a year during open enrollment, and then promptly forget about until they need them. Meanwhile, benefits professionals are working tirelessly to create informative materials, host webinars, and answer questions.

The frustration – Employees don’t read the communications, or they don’t attend the info sessions.  Unfortunately, when they do engage, it’s often at the last minute, or worse, after a deadline has passed.

Why it matters – When employees don’t understand their benefits, they can’t make informed decisions. This can lead to dissatisfaction, avoidable expenses, and unnecessary stress, both for the employees and the benefits team.

The uphill battle – Getting employees to engage requires creativity, persistence, and sometimes a touch of humor. It’s about making benefits feel approachable and relevant while cutting through the noise of overflowing inboxes and workplace distractions.

At the end of the day, benefits professionals are more than just “HR people.” They’re problem-solvers, negotiators, educators, and advocates. They play a crucial role in shaping the employee experience and supporting the overall health and well-being of the workforce.

So, the next time you find yourself navigating your benefits portal or asking a question about coverage, take a moment to appreciate the hard work that goes into making it all possible. Behind every plan, policy, and portal is a team of benefits professionals who genuinely care about making your life better, even if you don’t notice them.

As we head into the busiest season for most benefits teams, let’s give them the recognition they deserve. And if you’re a benefits professional reading this? Take a deep breath. You’re doing amazing work, and it doesn’t go unnoticed.

Here’s to you: the champions of healthcare plans, the wizards of wellness programs, and the masters of multitasking. The workplace wouldn’t be the same without you!

​In today’s competitive job market, employees are no longer solely motivated by a paycheck. Many candidates are seeking jobs that offer not only fair compensation but also a comprehensive benefits package.

​In fact, some studies show that employees are willing to accept lower salaries in exchange for better benefits. So, what exactly do employees value most when it comes to benefits? As an employer, understanding these preferences can help you attract and retain top talent, improve employee satisfaction, and foster a culture of loyalty. Let’s take a closer look at the top benefits employees are seeking and why they matter.

 It’s no surprise that health benefits are the most sought-after perk among employees. In an increasingly unpredictable world, access to affordable healthcare is more than just a luxury—it’s a necessity. With rising healthcare costs and the uncertainties of life, employees want to know that they have a safety net in place should the unexpected occur. For many, health benefits offer the peace of mind that, if they or a loved one faces a medical issue, they won’t be burdened with obscene medical bills.

Moreover, employees with health insurance are more likely to seek out preventative care. When people are covered, they are more inclined to get regular check-ups, screenings, and follow necessary treatments. This proactive approach not only keeps individuals healthier, but it also reduces absenteeism and increases productivity in the workplace. In essence, investing in health benefits is an investment in your employees’ long-term well-being and your company’s overall success.

​Takeaways: 

• Health benefits give employees the security they need to deal with life’s uncertainties.
  • Coverage encourages preventative care, leading to healthier, more productive employees.
  • Access to healthcare for employees and their families promotes overall well-being.

While dental and vision insurance may not be as high on the priority list for employees as health insurance, they are still vital. Dental and vision care is expensive, and many employees are concerned about the impact of these costs on their overall health and finances. Regular dental check-ups and vision exams are integral parts of maintaining good health, which is important to employees. By offering dental and vision insurance, you are supporting your employees in maintaining their health and well-being, which, in turn, leads to a more focused, productive, and satisfied workforce.

Takeaways: 

• Dental and Vision benefits reduce the financial burden on employees, allowing them to focus on their work and personal lives.
• Healthy employees are happier and more productive, and dental/vision benefits contribute to that.

The saying “work to live, don’t live to work” resonates with many employees today. In a world where work can often feel all-consuming, employees are seeking more balance between their professional and personal lives. This is where Paid Time Off (PTO) and different leave policies come into play.

Employees want to know that they will have time to recharge, take care of personal matters, and enjoy life outside of work. Providing a reasonable amount of paid time off is not just a luxury—it’s an investment in the well-being of your workforce. Time away from work leads to reduced burnout, increased job satisfaction, and better overall performance when employees return.

Paid time off typically includes vacation days, sick leave, personal leave, and holidays. Additionally, many employees now seek parental leave or other family-related leave benefits to support them during significant life events. Employees who feel supported by their employer during life’s milestones—whether that’s the birth of a child or caring for a sick family member—are more likely to be loyal, engaged, and committed to their role.

Takeaways:

• Paid time off is crucial for a healthy work-life balance, reducing stress and burnout.
• Employees with time to recharge are more productive and engaged.

Retirement may seem far off for some employees, but that doesn’t mean they aren’t thinking about it. Retirement benefits, especially employer-sponsored or contributed retirement plans like 401(k)s, are a significant factor when employees evaluate job offers.
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Employees want to feel confident that they are building a secure financial future and knowing that their employer is helping them save for retirement provides a sense of stability and security.

Retirement plans also act as a powerful retention tool. Employees who have access to decent employer-contributed retirement savings programs are more likely to stay with a company long-term. It shows that the employer is committed to helping them achieve financial independence and peace of mind in their post-working years. Employers can make these plans even more attractive by offering matching contributions or additional financial planning services.

Takeaways:

• Employer-sponsored retirement plans help employees plan for a secure future.
• Retirement benefits demonstrate a long-term commitment to employee well-being.
• Offering retirement benefits can help retain employees and reduce turnover.

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As an employer, offering these top benefits is essential to attracting and retaining talented employees. However, it’s not just about checking off a list—it’s about providing meaningful benefits that genuinely improve the lives of your workforce. Here are a few steps you can take to optimize your benefits package:

• Offer Comprehensive Health Coverage: Ensure that your health benefits plan is comprehensive and affordable. Offering a variety of plans or flexible options will appeal to employees with different needs and family situations.

• Communicate Benefits Clearly: Make sure your employees understand the benefits available to them. Regularly communicate updates, changes, and the value of each benefit. This will help employees appreciate what they’re receiving and how it can positively impact their lives.

• Encourage Regular Health Screenings: Promote wellness by encouraging employees to take full advantage of their health, dental, and vision benefits. This can foster a culture of health within your workplace.

• Foster a Positive Work Environment: PTO is only valuable if employees feel they can take time off without guilt or negative repercussions. Promote a culture that values time away from work and encourages a healthy work-life balance.

• Invest in Long-Term Financial Planning: Retirement plans are key to long-term employee satisfaction. Be sure to offer a plan that employees can rely on and consider providing financial literacy workshops or consulting to help them plan for their futures.

​Benefits today are not just a “nice-to-have”, they are a critical component of employee satisfaction and retention. By offering a comprehensive benefits package that includes health coverage, life insurance, PTO, retirement plans, and more, you create a work environment that supports your employees both personally and professionally. These benefits not only improve the quality of life for your employees but also contribute to a more productive, loyal, and engaged workforce.

Ultimately, investing in your employees’ well-being is an investment in the future success of your company. By aligning your benefits offerings with the needs and priorities of your employees you are helping your team thrive. Thus, ensuring your company remains a great place to work for years to come!
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Legal Disclaimer:
​The information in this website is provided for general informational purposes only, and may not reflect the current law in your jurisdiction. No information contained in this post should be construed as legal advice from CobraHelp. or the individual author, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this Post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country or other appropriate licensing jurisdiction.

​As an employer, you play a crucial role in helping your employees navigate the complexities of health insurance transitions, particularly when it comes to COBRA.

The loss of a job or a significant change in employment status can be overwhelming for employees, and ​providing clear guidance can make a significant difference in their experience. In this article, we’ll explore how employers can effectively support their employees during this transition.

Acknowledge the Confusion
When employees lose their jobs, they often face a whirlwind of emotions and uncertainties. The transition to COBRA can add to this stress. It’s essential to acknowledge that many employees may find this process confusing and overwhelming. By recognizing this, Employers can approach the situation with empathy and understanding, reassuring them that assistance is available.

Reporting a COBRA Qualifying Event
Any successful transition starts at the beginning. When it comes to COBRA coverage, timely reporting of a qualifying event is crucial. To ensure a smooth transition to COBRA benefits, it’s best to report the event—such as their last date worked—immediately or as close to that date as possible. This helps avoid any lapses in coverage and allows CobraHelp to issue the necessary election notice promptly. The sooner you act, the greater the chances of minimal interruption in active benefits.

Connect Them with CobraHelp
One of the most effective ways to support employees is to inform them about CobraHelp. Our dedicated service specializes in COBRA administration and has a team of COBRA Participant Specialists ready to assist employees (and employers) with any questions they might have. It isn’t a call center where representatives are reading off of a script. Instead, members with CobraHelp receive the support and personalized service that they need. Encourage employees to reach out to CobraHelp directly for guidance on their coverage options, paperwork, and deadlines. This connection can help alleviate some of their anxiety and provide them with the expert support they need.

Under COBRA, there are certain rules that allow eligible individuals with disabilities (or their qualifying dependents) to get an extension on the regular 18-month coverage period to 29 months total. In order for an individual to qualify for the extension of COBRA insurance coverage due to disability, a qualified beneficiary must be deemed disabled by the Social Security Administration (SSA) and meet several other criteria.

​COBRA Participants who have been deemed disabled by the SSA should notify the Plan Administrator of the disability determination right away. The plan should have rules set that indicate how the notice should be provided, including contact details. Plans generally require that the notice of disability determination from the SSA should be provided to the Plan Administrator (or designated contact) within the first 18 months of the COBRA continuation coverage and within 60 days of the later of:

1. When the individual received the SSA Notice of Award or;
2. When the COBRA continuation coverage began.

The premium payment requirements can be different during the extended 11 months of coverage as Plans are allowed to charge up to 150% of the premium to the Participant(s).

One question we often receive regarding the length of COBRA continuation is, “How do I know what the maximum period of coverage should be for my employee?”

In this article, we’ll take a closer look at several common extensions of COBRA that can influence the maximum coverage period for certain qualified beneficiaries based on state-specific legislation.

Presently, there are only four States which have legislation that works in conjunction with Federal COBRA coverage laws under certain circumstances. They are New York, Connecticut, Texas, and California.

New York COBRA Extension: On November 19, 2009, Governor David A. Paterson signed into law Chapter 498 of the Laws of 2009, which amends Insurance Law §§ 3221(m), 4304(k), 4305(e), and section 4 of Chapter 236 of the Laws of 2009 and this describes the COBRA state extension coverage from the standard 18 months to 36 months (maximum). This rule applies to medical coverage only so dental and vision maximum coverage periods remain typical (18, 29, or 36 months depending upon qualifying event type). This COBRA extension is also applicable based on where the group health plan was written and NOT based on the employer’s locality being headquartered in the State of New York. The primary exemption to the rule applies to self-funded plans who do not have to extend federal COBRA coverage laws beyond 18 months for 18-month qualifying event types.

Connecticut COBRA Extension: On May 5, 2010 Gov. Rell signed into law Public Act 10-13, which changed the length of time employees who lose coverage under Connecticut fully insured employer health insurance plans may stay on COBRA continuation coverage. Qualified beneficiaries (COBRA eligible persons) can elect COBRA continuation coverage for up to 30 months in the event of layoff, reduction of hours, leave of absence, or termination of employment. The exemption is that self-funded plans are not required to participate in offering the COBRA extended coverage period beyond 18-months. Dental and vision plans are not eligible for the extension, and so this applies to medical coverage only, similar to the New York extension of COBRA continuation coverage. These COBRA extension rules do not apply to an employer based on location but rather apply based on where the group health policy was written/signed. For example, a Rhode Island employer who may have a fully insured group health policy out of Connecticut will then comply with the extension to 30 months on 18-month COBRA events.

Texas COBRA Extension: Texas law 1251.251, part of the Texas Insurance Code, indicates that any individual who has exhausted COBRA coverage with a termination of employment, leave of absence, layoff, or reduction of work hours qualifying event may extend COBRA coverage (medical only) for an additional 6 months beyond the standard 18 months for a total of 24 months of COBRA continuation coverage. This rule applies to fully insured plans, as self-funded plans are exempt. Like the other states mentioned earlier, the Texas extension of COBRA benefits applies to medical coverage only, and dental and vision plans are not eligible. This, like the New York and Connecticut COBRA state extension, is based on policies signed in the State of Texas, not based on the Employer’s location.

California COBRA Continuation aka “Cal-COBRA”: While coverage under Cal-COBRA is considered State Continuation and is entirely separate from Federal COBRA coverage law, this one is worth mentioning as it is a unique COBRA insurance extension that works in conjunction with Federal COBRA. In fact, directly following 18 months of Federal COBRA, many qualified beneficiaries are eligible to continue coverage through conversion onto California State Continuation (Cal-COBRA) for another 18 months, or for up to a total of 36 consecutive months of continuation coverage so long as the qualified beneficiary remains eligible during that time and has completed the enrollment process(es) and remitted premiums. Cal-COBRA is also unique in that it is generally administered by the California insurance carriers directly, so it is quite common for individuals who have completed 18 months of Federal COBRA to enroll directly with carriers into Cal-COBRA and pay the carrier directly for those continuation coverage premiums.

Other Rules:
Keep in mind there are other maximum coverage periods discussed within the COBRA coverage law, such as the disability extension to 29 months or extension based on second qualifying events that may occur, but this article summarizes the extensions related to State-specific legislation that works directly with COBRA coverage.
If you have questions about extending coverage periods for your employees or COBRA participants, we encourage you to work with a COBRA Expert to determine the best course of action.
​
Legal Disclaimer:
​The information in this website is provided for general informational purposes only, and may not reflect the current law in your jurisdiction. No information contained in this post should be construed as legal advice from CobraHelp. or the individual author, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this Post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country or other appropriate licensing jurisdiction.

It’s the most wonderful time of the year! With chilly mornings, fallen leaves (and in some places, snow), supermarkets filled with signs of Thanksgiving feasts

and holiday decorum, we can all feel the holiday season is upon us. Workload management strategies during this period are crucial.

In the workplace, the holiday season often brings a busy influx in workload or changes within a business that can cause disruption to your everyday workflow and holiday strategic planning.

​These kinds of changes often lead to holiday oversights involving HR departments, insurance agents, and employees so let’s take a look at a couple examples and how you can avoid them.

Holiday Blues:
My employee was going through a divorce around Thanksgiving, and unfortunately, she forgot to notify the Plan of the divorce within 60 days as our plan terms require. We informed her of this fact, but then learned that she was never made aware of her requirement to report the divorce to us in time. Are we on the hook for her ex-spouse’s benefits?

Answer: Maybe. While the employer in the aforementioned scenario may need to provide some sort of “self-insured” coverage for the former spouse, the ramifications of not furnishing the employee and her spouse a General COBRA Rights Notice (aka Initial Rights Notice) can be far worse than just paying claims out of the employer’s pocket. Not only can the IRS penalize this employer with hefty (per diem) fines, but the employee/former spouse may sue the employer for the coverage rights that the former spouse was not ever made aware of. This can lead to a costly (and time-consuming) lawsuit, expensive claims, and a whole lot of headache for the Company, and all parties involved. Effective workload management strategies should be implemented to avoid such scenarios.

A Christmas Conundrum:
With our group health renewal happening December 1st — right around the holidays, we completely forgot to inform our COBRA qualified beneficiaries that the new plan the company has selected for the new plan year is a bundled plan which now includes medical, dental and vision as part of our holiday strategic planning. One plan cannot be elected without the other but we failed to inform the COBRA eligible persons. Now they’ve been paying the wrong premium amounts, and some don’t have the correct enrollment with the carrier(s). What happens now?

Answer: Without proper open enrollment notification, the employer is out of compliance but the issue is more complex than that. The qualified beneficiaries involved in this sort of scenario must be informed of the plan changes, rate changes, and ultimately their coverage must be corrected, even if that costs the employer several thousands in premiums. If the carrier(s) won’t allow a retroactive correction, the employer may be on the hook for “self-insuring” the COBRA beneficiaries for “x” number of months to bridge the gap between when coverage was elected and when coverage changes occurred. Further, this kind of oversight could lead to a lawsuit as employees may feel that their COBRA rights were violated or that their claims were rejected due to an oversight like the one described.
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How to Avoid Holiday Horrors Like These?

Human Resource professionals and insurance agents are encouraged to organize the COBRA compliance related tasks ahead of time before the holiday season hits and discuss what tasks need to be managed as well as determine who will be responsible for what. Further, Employers are encouraged to consider outsourcing COBRA compliance duties to a professional third-party who helps keep things on track and keeps employers out of a courtroom. Top tier COBRA administration and organized, holiday strategic planning, can help HR departments stay on track and can aid insurance brokers in managing certain tasks on behalf of their clients so that things don’t slip through the cracks. Also consider a post-holiday audit similar to the ones CobraHelp conducts for our clients, ensuring that nothing was missed. Workload management strategies play a significant role in this process.

Any third-party administrator should check the work they perform to ensure accuracy and timeliness so ask your vendors if this is something they provide as part of the standard services.

If you have questions about COBRA and benefits compliance, please don’t hesitate to contact us at CobraHelp. We’re here for you this holiday season and always.

Happy Holidays from our team to yours!

The past several years in the world of employee benefits have been unique to say the least. With the pandemic came major changes in the healthcare and employee benefits

sectors which impacted everything from administration requirements to financial aspects of these industries. Let’s take a look at what the end of COVID19 COBRA tolling means for employers and group health in 2023 and beyond…

​The tolling allowed for COBRA timeframes during the COVID19 National Emergency caused “suspension” of typical COBRA deadlines for the past three years. Simply put, COBRA administrative guidelines allowed COBRA qualified beneficiaries who met certain requirements could pay premiums on a delayed basis, and could elect later than the normal 60-day election period. Employers and Plans were allowed more time to report events, and had special extensions for their administrative duties. Special enrollment rights were also temporarily modified, allowing qualified beneficiaries more time to enroll under qualifying circumstances.

By mid-September 2023, with the previous announcement from the President in April 2023, we saw pre-COVID19 COBRA guidelines return to employee benefits administration. But because it has been several years, many plans are finding it a challenge to go back to the “old timelines”. This is completely understandable as our industry was essentially overhauled for the past three years and “new-old” regulatory compliance standards are understandably a memory jog for many benefits professionals.

In this article, we will address some of the pre-COVID COBRA requirements that may have been forgotten during these past several years. Now that all time-lines are “back on track” when it comes to COBRA, COBRA administrative guidelines, Employers, and Plan Administrators need to ensure that they are not violating any reporting requirements. COBRA notification requirements suggets employers should always have a plan for how to ensure COBRA qualified beneficiary notifications, election, payment periods, coverage enrollment, etc are handled in a timely manner. No more “tolling” means stricter deadlines and timelines for each administrative duty. Unfortunately for Employers, Employees and Qualified Beneficiaries alike, missing important deadlines can result in hefty penalties, claims, or lack of coverage altogether.

COBRA Notification Requirements. An employer that is subject to COBRA requirements must notify its group health plan administrator within 30 days after an employee has experienced a qualifying event such as employment termination or reduced hours. Within 14 days of that notification, the plan administrator must notify the qualified beneficiary of his or her COBRA rights (not to be confused with a General COBRA Notice aka Initial Rights Notice).

(This article pertains to Federal COBRA.  See state-specific requirements for state continuation aka “mini cobra” plans).

If the employer is also the plan administrator, and issues COBRA notices directly, the employer has the entire 44-day period in which to issue a COBRA election notice.

Employees also have notification requirements in order to ensure that qualified beneficiaries such as covered spouses and children have opportunity to elect COBRA. For example, the employee must report certain dependent events such as divorce, legal separation or a child’s loss of dependent status within 60 days to the Plan Administrator.
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This is one of many reasons why Initial Notifications (aka General Notice of COBRA Rights) are imperative, as these notices, which must be issued to the employees within 90 days of enrollment into group health benefits, highlight all of the employee’s rights under COBRA, including the requirements and timelines to report certain events.

Election Period. Qualified Beneficiaries must be given an election period of at least 60-days from the later of: the date of notification or the date of the loss of coverage to choose whether to elect continuation coverage under COBRA.

Reporting Enrollment. While employers should always report new COBRA enrollments as soon as possible to the carriers, so as not to delay eligibility processing and coverage activation, employers have 30 days to inform the Plan of a new election.

Initial Payment Period. COBRA qualified beneficiaries have 45 days from the date of election to remit the initial premium payment which means coverage activation is often retro-active.

Regular On-Going Premium Payments – 30 Day Grace Period. Enrolled COBRA Participants will then have a minimum of 30 days from each premium coverage period due date to remit premiums for the coverage. For example, premiums due on the 1st of the month must be paid on or before the 30-day grace period. If premiums are not paid timely, this can result in early coverage termination.

Reporting Coverage Terminations for non-payment to Carriers. Each Plan has its own unique rules and plan terms and so it is imperative that employers learn about their group health plan rules for reporting termination timely. Most commonly, COBRA terminations of coverage must be reported within 30 to 60 days of the termination date being requested, depending upon termination reason. Plans should be aware of COBRA regulations as they will need to take into consideration the COBRA rules and timeframes, which exceed the ‘’typical” due dates for premiums and election.

Other Notifications and Requirements. There are a variety of other notifications related to COBRA that must be sent to qualified beneficiaries, and a plethora of other regulatory requirements pertaining to COBRA continuation coverage. This is why a thorough knowledge of COBRA and ERISA requirements or outsourcing to a reliable, expert is key for an Employer’s success in accurate, timely, and ethical benefits administration.

Legal Disclaimer:
​The information in this website is provided for general informational purposes only, and may not reflect the current law in your jurisdiction. No information contained in this post should be construed as legal advice from CobraHelp. or the individual author, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this Post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country or other appropriate licensing jurisdiction.

COBRA qualifying events are different from “life events” that impact health coverage or employee benefits.

In this article, we take a closer look at events and which employees or dependents  they impact, as well as how long a person can be enrolled in COBRA continuation coverage.

​A COBRA qualifying event is such that it causes the qualified beneficiary to lose coverage under the plan. For example, an employee getting married, is not a COBRA qualifying event. Rather, it is considered a life event. The marriage of the employee to the new spouse does not cause a loss of coverage.

The following graphic demonstrates the maximum periods of coverage that continuation coverage must be offered for the different types of qualifying events that impact employees and their covered family members when it comes to COBRA compliance. These employees and covered dependents shown below are called “qualified beneficiaries” if they experience a COBRA event, and this means that they are entitled to elect continuation coverage when an event occurs.

It’s no secret that navigating Medicare can be a challenge all it’s own. But add COBRA compliance into the mix, and you’re sure to stumble upon an HR conundrum.

Not to worry. Fortunately, there are Medicare and COBRA Experts who are able to help with frequently asked questions that pertain to an employee or retiree’s options to continue coverage, bridging the gap between active benefits and Medicare entitlement.

​In this article, we’ll visit Medicare & COBRA extension for spouses and a specific example of how a covered spouse’s coverage would be handled in the event that an employee’s COBRA coverage ceased due to Medicare entitlement.

First, let’s take a quick look at the often misunderstood term – “Medicare entitlement”. Contrary to popular belief, the term “Medicare Entitlement” when dealing with insurance related matters or regulatory compliance is actually referring to when an individual enrolled into Medicare, and  not referencing when that person became eligible for Medicare. For example, when we say that Sally Doe became entitled to Medicare as of 03/01/2023, what this means is that she was enrolled into Medicare, most commonly due to turning 65, effective 03/01/2023.

Next, to help simplify the complexity of determining a covered spouse’s eligibility for 36 or 18 months of COBRA when the primary insured becomes entitled to Medicare, let’s use a real life example.

Recently, an employer asked us how to handle the coverage of a retiree who is enrolled in COBRA continuation coverage with his wife now that the employer has been informed that the retiree had enrolled in Medicare in March of 2021.
For the purposes of this article, Medicare & COBRA extensions for spouses, let’s call the retiree Bob Sample and his wife Sally Sample.

Here’s the gist:
Bob turned 65 in March 2021, and so he enrolled into Medicare effective 03/01/2021. Bob’s covered spouse Sally, is not yet entitled to Medicare, and needs coverage until she reaches age 65. Under COBRA, the law addresses the rights of dependents in certain circumstances to extend COBRA from 18 months (regular termination of employment qualifying event when Bob retired) to 36 months (maximum period of COBRA continuation coverage).

The thing is, not all qualified beneficiaries are eligible for this extension and eligibility dates and timeframes impact that determination, which makes Medicare + COBRA challenging to navigate.

To determine the answer to the Employer’s question, we must first look at the timing of Bob’s Medicare entitlement and compare that to his original qualifying event date.
Bob and Sally Sample became eligible for COBRA on 04/01/2022, which is after Bob’s Medicare entitlement that occurred back on 03/01/2021.

Because of this fact, and the fact that the original qualifying event was an 18-month event such as termination of employment, in this case Sally is eligible for the COBRA extension to 36 months total from the original event date.

Sally is allowed to utilize COBRA continuation coverage from 04/01/2022 through 02/29/24, a total of 36 months.

This is because Bob’s Medicare entitlement occurred on or before the COBRA qualifying event date.

Alternatively, there are many cases in which the qualified beneficiary is not eligible for the 36 months of continuation coverage when the Medicare entitlement of the primary insured occurs after the COBRA qualifying event.

RESPONSIBILTIES:

Qualified beneficiaries should report changes such as these, or requests for Medicare & COBRA extensions for spouses, and changes in coverage to the Plan Administrator before the close of the initial 18 – month period of COBRA continuation coverage and ensure that they have requested these changes within appropriate timeframes and in accordance with Plan terms.
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Employers should ensure that their employees and COBRA participants are aware of their rights and responsibilities, including how to inquire about a spouse’s eligibility for a COBRA extension of coverage.