An Employer'S Guide To Group Health Continuation Coverage Under Cobra - Employee Benefits Security Administration - U.s. Department Of Labor Page 12
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19Early Termination
A group health plan may terminate continuation coverage earlier than the end of the maximum period for any of the
following reasons:
•
Premiums are not paid in full on a timely basis;
•
The employer ceases to maintain any group health plan;
•
A qualified beneficiary begins coverage under another group health plan after electing continuation coverage;
•
A qualified beneficiary becomes entitled to Medicare benefits after electing continuation coverage; or
•
A qualified beneficiary engages in conduct that would justify the plan in terminating coverage of a similarly
situated participant or beneficiary not receiving continuation coverage (such as fraud).
If continuation coverage is terminated early, the plan must provide the qualified beneficiary with an early termination notice.
(See COBRA Notice and Election Procedures earlier in this booklet.)
Extension of an 18-month Period of Continuation Coverage
There are two circumstances under which individuals entitled to an 18-month maximum period of continuation coverage
can become entitled to an extension of that maximum. The first is when one of the qualified beneficiaries is disabled; the
second is when a second qualifying event occurs.
Disability
If one of the qualified beneficiaries in a family is disabled and meets certain requirements, all of the qualified beneficiaries
in that family are entitled to an 11-month extension of the maximum period of continuation coverage (for a total maximum
period of 29 months of continuation coverage). The plan can charge qualified beneficiaries an increased premium, up to 150
percent of the cost of coverage, during the 11-month disability extension.
The requirements are, first, that the Social Security Administration (SSA) determines that the disabled qualified beneficiary
is disabled before the 60th day of continuation coverage and, second, that the disability continues during the rest of the
initial 18-month period of continuation coverage.
The disabled qualified beneficiary (or another person on his or her behalf) also must notify the plan of the SSA
determination. The plan can set a time limit for providing this notice of disability, but the time limit cannot be shorter than
60 days, starting from the latest of: (1) the date on which SSA issues the disability determination; (2) the date on which the
qualifying event occurs; (3) the date on which the qualified beneficiary loses (or would lose) coverage under the plan as a
result of the qualifying event; or (4) the date on which the qualified beneficiary is informed, through the furnishing of either
the SPD or the COBRA general notice, of the responsibility to notify the plan and the procedures for doing so.
The right to the disability extension may be terminated if SSA determines that the qualified beneficiary is no longer
disabled. The plan can require disabled qualified beneficiaries to provide notice when such a determination is made. The
plan must give the qualified beneficiaries at least 30 days after the SSA determination in which to provide such notice.
The rules for how to give a disability notice and a notice of no longer being disabled should be described in the plan’s SPD
(and in the election notice for any offer of an 18-month period of continuation coverage).
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UNITED STATES DEPARTMENT OF LABOR
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