COBRA
Effective September 1, 2011, EBS-RMSCO is Penn State’s COBRA administrator.
Employees eligible for COBRA will receive information following their qualifying event directly from EBS-RMSCO, not the Employee Benefits Division. All questions regarding COBRA benefits after an individual is enrolled in COBRA should be directed to EBS-RMSCO at 800-828-0078. Employees currently enrolled in COBRA will receive information and payment premium coupons from EBS-RMSCO.
What is COBRA?
COBRA stands for Consolidated Omnibus Budget Reconciliation Act, it’s a federal law that provides employees and/or their covered dependents, who lose their health benefits as a result of certain qualifying events, the right to extend their medical, dental and vision benefits, temporarily, at group rates.
Qualifying events are specific occurrences that would cause the loss of health benefits.
What are the qualifying events for an employee?
- Reduction in the number of hours worked affecting your benefits eligibility
- Termination of employment (other than for misconduct), including retirement or layoff 1
1 - In the case of a layoff, you may maintain coverage for the first 120 days, at the regular contribution rate. At the end of the 120 days, you have the option to continue coverage for an additional 14 months under COBRA. However, continuation of coverage may not extend beyond 18 months.
What are the qualifying events for a spouse or dependent?
- Reduction in number of hours of employment of the covered employee affecting benefit eligibility
- Termination of employment (other than for gross misconduct) of the covered employee
- Divorce from the covered employee
- Death of the covered employee
- Loss of "dependent child" status under health plan rules
After a qualifying event, what steps do I need to take to continue my health benefits?
Divorce or change in child's dependent status – you are responsible for notifying the Benefits Division within 60 days of the event.
Death of Employee or termination/reduction in hours - the University is responsible for notifying the Plan Administrator of the qualifying event within 30 days of that event.
Within 14 days of receiving notification from the Plan Administrator, EBS-RMSCO is responsible for providing you and your covered dependent(s), a written notice of COBRA rights as well as the application for COBRA coverage.
If you and/or your covered dependent(s) choose to elect COBRA coverage, you must submit your application for coverage to EBS-RMSCO, as will be indicated on the information you receive from them.
2011 Premiums
| PPO Blue | |
|---|---|
| Participant | $472.77 |
| Family | $1,243.38 |
| Dental | |
| Participant | $29.06 |
| Family | $76.34 |
| Vision | |
| Participant | $4.00 |
| Family | $12.00 |
Premiums are due by the first of each month. Premiums will be adjusted each January 1 and will reflect the rates listed below.
2012 Premiums
| PPO Blue | |
|---|---|
| Participant | $492.10 |
| Two Party | $1101.26 |
| Parent/Child(ren) | $1045.37 |
| Family | $1,419.41 |
| Dental | |
| Participant | $29.06 |
| Family | $76.34 |
| Vision | |
| Participant | $4.00 |
| Two Party or Parent/Child(ren) |
$7.83 |
| Family | $12.02 |
What is the length of coverage under COBRA?
| Qualifying Event | Qualified Beneficiaries 1 | Length of Coverage |
|---|---|---|
| Reduction in number of hours of employment | Employee, Spouse, Dependent Child | 18 months 2 |
| Termination of employment of the covered employee | Employee, Spouse, Dependent Child | 18 months 2 |
| Divorce | Spouse, Dependent Child | 36 months |
| Termination of employment of the covered employee | Spouse, Dependent Child | 36 months |
| Loss of "dependent child" status 3 | Dependent Child | 36 months |
1 - See Extension of Coverage
2 - Each qualified beneficiary has the right to elect COBRA coverage independently of one another. In considering whether to elect COBRA coverage, be aware that a failure to continue your group health coverage will affect your future rights under federal law.
3 - See Health Insurance Eligibility Guidelines
Extension of Coverage
Extensions of coverage are only applicable for instances of termination or reduction of hours. There are two ways in which beneficiaries may be eligible.
Disability - If a qualified beneficiary becomes disabled under Title II or XVI of the Social Security Act during the first 60 days of COBRA coverage, then all the qualified beneficiaries may be able to extend COBRA coverage for another 11 months, increasing the coverage to a maximum of 29 months.
If a qualified beneficiary becomes disabled under Title II or XVI of the Social Security Act before the first day of COBRA coverage they are considered to be disabled within the first 60 days of COBRA coverage, provided they are still disabled on the first day of COBRA coverage.
If you elect this extension of coverage, the additional 11 months premium will be 150% of the plan's total cost of coverage. In addition, the qualified beneficiary must notify the Plan Administrator of both the disability determination and the disability termination (if applicable), within 60 days of each determination.
Second Qualifying Event - If a second qualifying event occurs during the initial 18 or 29 month period, the spouse and/or dependent child may be eligible for an extension of coverage to a maximum of 36 months. To be eligible for the extension of COBRA coverage, you must notify the Benefits Division of the second qualified event within 60 days of the event. In no instance, would coverage be granted beyond the maximum of 36 months.
Termination of Coverage
Coverage may be terminated earlier if:
- Premiums are not paid on time
- Coverage is obtained through another group health plan that does not have any pre-existing condition limitation or exclusion. If such coverage is obtained prior to COBRA election, the COBRA coverage may not be terminated early
- A qualified beneficiary ceases to be disabled during the period of extended coverage
