Typically, eligibility ends after the 12 weeks of FMLA leave is complete. In general, employers or plan administrators are required to offer COBRA when the employee no longer meets the eligibility requirements of a benefit plan, and the employee no longer is protected by federal or state leave laws. A review of the plan’s summary plan description (SPD) will confirm eligibility requirements.
An employee should be offered COBRA if the employee no longer is eligible to remain on the group health plan. The COBRA participant will be eligible for either 18 months of COBRA coverage or an extension of COBRA to 29 months of coverage if specific criteria for a disability extension are met, to which all of the following conditions must be met:
- The Social Security Administration (SSA) must determine the beneficiary to be “disabled” by the on any day before electing COBRA coverage.
- The employee has qualified for COBRA coverage on the basis of her/his reduction of hours or termination.
- The beneficiary must notify the plan administrator of his or her disability within 60 days after the latest of any of the following:
- The date of the Social Security Administration’s determination of disability (as provided in a letter from the Social Security Administration).
- The date of the qualifying event (i.e., reduction of hours or termination) in which s/he lost coverage under the health plan.
- The date on which s/he would lose coverage under the plan.
- The date s/he is provided employer notification and is informed of her or his obligation to provide notice of the disability to the plan administrator.
- The beneficiary must notify the plan administrator before the original 18-month maximum coverage period ends.
The maximum coverage period for COBRA will be 29 months, if all conditions are met. This is measured from the same date the original coverage started. 11 additional months are added on from the date the original coverage of 18 months began to total the 29 months.
Disclaimer: The response above is in general terms. Every plan administrator and employee situation is different. Please contact HR Knowledge, Inc. at Sales@hrknowledge.com or call at 508-339-1300 for more comprehensive guidance..