Clarity COBRA FAQs for Employees

COBRA stands for the Consolidated Omnibus Budget Reconciliation Act, a federal law in the United States that allows eligible employees and their dependents to continue receiving health insurance coverage when they would otherwise lose it due to certain qualifying events.

A COBRA qualifying event refers to a specific triggering event that makes an individual eligible for COBRA continuation coverage. 

Qualifying events that may make an individual eligible for COBRA continuation coverage include:

1. Termination of employment: When an employee's employment is terminated for reasons other than gross misconduct.
2. Reduction in work hours: If an employee's work hours are reduced, leading to a loss of eligibility for the employer's health insurance plan.
3. Divorce or legal separation: When a covered employee becomes divorced or legally separated from the spouse who was covered under the employer's health insurance plan.
4. Death of the covered employee: If the covered employee passes away, their dependents may be eligible for COBRA continuation coverage.
5. Medicare entitlement: When the covered employee becomes entitled to Medicare benefits, their dependents may be eligible for COBRA continuation coverage.
6. Loss of dependent status: If a dependent child no longer qualifies as a dependent under the terms of the employer's health insurance plan.

To be eligible for COBRA continuation coverage, you generally need to have been covered under your company's group health insurance plan on the day before a qualifying event occurs. However, there is no specific minimum duration of coverage required before becoming eligible for COBRA. If you were enrolled in your employer's group health insurance plan at the time of the qualifying event, you and your covered dependents may be eligible for COBRA.

Under normal circumstances, COBRA continuation coverage can generally last for a maximum period of 18 months. However, the qualifying events listed above can extend the duration of COBRA coverage for both the qualified beneficiary and their dependents.

If you become disabled while on COBRA continuation coverage, it may have an impact on the duration of your COBRA coverage. Under certain circumstances, the maximum period of COBRA coverage can be extended beyond the standard 18-month period.

If a qualified beneficiary (such as yourself) becomes disabled within the first 60 days of COBRA coverage, the coverage period can be extended to a maximum of 29 months. This extension is available if the Social Security Administration determines that the qualified beneficiary meets the definition of disability under the Social Security Act.

To qualify for this disability extension, the following criteria generally apply:

1. The disability must occur within the first 60 days of COBRA coverage.
2. The disability must be recognized and approved by the Social Security Administration.
3. The qualified beneficiary must notify the plan administrator of the disability determination within 60 days of receiving it or before the end of the standard 18-month COBRA coverage period (whichever is later).

The coverage of a domestic partner under COBRA depends on the specific provisions of the employer's health insurance plan and whether domestic partners are recognized as eligible dependents for coverage. COBRA generally allows for the continuation of health insurance coverage for qualified beneficiaries who were covered under the employer's group health plan before a qualifying event occurred. Qualified beneficiaries typically include the covered employee, their spouse, and their dependent children.

Once you receive your Specific Rights notice, you have 60 days to elect COBRA coverage. To elect coverage, you simply need to login to the Clarity Portal, select the COBRA tile and follow the instructions.

COBRA is a federal law providing certain rights to continue your Health, Dental, Vision, Health Flexible Spending Account, and certain EAPs. It also imposes certain responsibilities. Paying all premiums due from the loss of coverage.

Your first premium is due 45 days from your COBRA election. Subsequent premiums are due the 1st of each month but must be postmarked no later than the 30th. The insurance carrier has the right to suspend your coverage between the 1st and 30th, reinstating benefits when premiums are received.

No, you generally cannot make changes to your COBRA coverage itself. COBRA continuation coverage is designed to provide you with the same health insurance coverage that you had while you were an active employee. It is intended to be a continuation of your previous coverage, not a new enrollment opportunity. However, there are certain circumstances where you may have the ability to make changes to your coverage. These situations typically occur during open enrollment periods or if you experience a qualifying event that would allow you to change your coverage options.

Yes, it is possible for your employer to change the insurance carrier while you are on COBRA continuation coverage. COBRA allows for the continuation of the same health insurance coverage that you had while you were an active employee. However, the employer has the ability to make changes to the insurance carrier or the specific plan offered to active employees. If your employer decides to change the insurance carrier, they must provide you with a comparable health insurance plan offered by the new carrier. The new plan should provide similar coverage and benefits as the previous plan. The premium cost and other terms of the coverage should also be similar to what was available before the change.

Health Flexible Spending Accounts (FSAs) are generally not subject to COBRA continuation coverage requirements. COBRA primarily applies to group health plans provided by employers that offer health insurance coverage. Health FSAs, on the other hand, are typically considered voluntary benefits that allow employees to set aside pre-tax dollars to pay for eligible medical expenses.

1. Your employer notifies Clarity Benefit Solutions that your coverage has been terminated within 30 days of the loss of coverage. 
2. Within 14 days, Clarity will send you a Specific Rights Notice by email and Mail.
3. You will have 60 days to make your COBRA election. 
4. Your first payment, including amounts due to-date, must be made within 45 days of the COBRA election. 
5. Once Clarity receives your COBRA election, Insurance Carrier forms (if applicable) and payment, the coverages elected will be reinstated back to the loss of coverage. 
6. Future payments are due on the 1st of the month and must be post-marked by the 30th of the month. Late payments will result in the termination of COBRA Benefits.