Oregon
Rule Rule 101-030-0005
Continuation of Group Medical and Dental Insurance Coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA)


COBRA allows an eligible individual who is losing an employers group health plan coverage due to a qualifying event to continue coverage for a limited time. The COBRA election process begins with a timely notice from either the covered employee or the qualified beneficiary of the event. PEBB COBRA is a self-pay premium by the eligible individual.

(1)

PEBB participating organizations will issue an initial COBRA notice to all newly eligible employees and individuals that explains the right to continue employer medical and dental insurance plans if lost.

(a)

The notice must be mailed to the eligible employees address of record or personally delivered to the employee within 90 days after coverage begins. The notice must include all PEBB covered individuals residing at the address. PEBB participating organizations must send a separate notice to the address of record for eligible individuals residing separately from the eligible employee.

(b)

PEBB participating organizations must also mail an initial COBRA notice to individuals who become newly eligible for PEBB coverage due to marriage or the formation of a domestic partnership.

(2)

To initiate COBRA eligibility a COBRA triggering event must occur causing the loss of benefit coverage. COBRA triggering events include:

(a)

An involuntary reduction in hours or layoff.

(b)

A strike or lockout.

(c)

The beginning of an unpaid leave of absence.

(d)

The termination of employment.

(e)

Retirement.

(f)

The loss of employer-sponsored group coverage for dependents due to Medicare eligibility.

(g)

The death of the employee.

(3)

A qualified beneficiary or covered employee must notify the plan administrator within 30 days of the event when a qualified beneficiary loses or will loss coverage due to:

(a)

A divorce or termination of a domestic partnership

(b)

A dependent child no longer satisfying eligibility requirements.

(4)

All individuals losing eligibility due to a triggering event must receive a COBRA continuation notice. An employees failure to report a spouse, domestic partner, or dependent childs loss of eligibility within 30 days of the event is an intentional misrepresentation of a material fact of enrollment by the employee. PEBB will rescind all coverage back to the last day of the month and plan year when eligibility was lost. Under COBRA regulations ineligible individuals removed more than 60 days from the eligibility loss date will receive a COBRA unavailability letter due to the employees late notification. PEBB participating organizations must notify PEBBs Third Party Administrator (TPA) within 30 days of the date of benefit eligibility. The date eligibility is lost is the COBRA triggering event date.

(a)

The PEBB TPA mails a COBRA notice of continuation, to each eligible individual at their last address of record when eligibility for PEBB-sponsored insurance coverage is lost. The TPA must mail the notice to each eligible individual within 14 days of receiving the notification.

(b)

An eligible employee has 60 days from the date of the COBRA notice to activate their COBRA rights of continuation. PEBB-sponsored insurance coverage must be continuous through COBRA implementation.

(5)

An eligible individual continuing PEBB medical or dental insurance coverage or both under COBRA provisions has the same rights as active eligible employees for making changes during the open enrollment period and is eligible for qualified midyear changes.

(6)

An eligible employee ending employment may continue to participate in the Healthcare Flexible Spending Account through COBRA up to the end of the current plan year if when the triggering event occurs:

(a)

They have a positive balance in their account, and;

(b)

They self-pay contributions to the account. Contributions after employment ends are paid on an after-tax basis.
Source
Last accessed
Dec. 13, 2019