An Employer'S Guide To Group Health Continuation Coverage Under Cobra - Employee Benefits Security Administration - U.s. Department Of Labor Page 15
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19Coordination with Other Federal Benefit Laws
The Family and Medical Leave Act (FMLA) requires an employer to maintain coverage under any “group health plan” for
an employee on FMLA leave under the same conditions coverage would have been provided if the employee had continued
working. Group health coverage that is provided under the FMLA during a family or medical leave is not COBRA
continuation coverage, and taking FMLA leave is not a qualifying event under COBRA. A COBRA qualifying event may
occur, however, when an employer’s obligation to maintain health benefits under FMLA ceases, such as when an employee
taking FMLA leave decides not to return to work and notifies an employer of his or her intent not to return to work.
The Affordable Care Act (ACA) provides additional protections for coverage under an employment-based group health
plan, including COBRA continuation coverage. These protections include:
•
Extending dependent child coverage to age 26;
•
Prohibiting limits or exclusions from coverage for preexisting conditions;
•
Banning lifetime or annual dollar limits on coverage for essential health benefits; and
•
Requiring group health plans and insurers to provide an easy-to-understand summary of a health plan’s benefits
and coverage.
Some plan sponsors may have chosen to make only routine changes and generally keep the coverage under their health
plan the same as it was on March 23, 2010. These grandfathered health plans are required to comply with some of the
ACA protections (including those noted above), but not all. Additional protections that may apply to non-grandfathered
health plans include coverage for:
•
Certain preventive services (such as blood pressure, diabetes and cholesterol tests, regular well-baby and well-
child visits, routine vaccinations and many cancer screenings) without cost sharing; and
•
Emergency services in an emergency department of a hospital outside your plan’s network without prior
approval from your health plan.
For more information regarding whether your plan is a grandfathered health plan and the requirements under the ACA,
visit the Employee Benefits Security Administration’s ACA Web page at dol.gov/ebsa/healthreform.
Certain Trade Adjustment Assistance (TAA) Program participants have a second opportunity to elect COBRA continuation
coverage. Individuals who are eligible and receive Trade Readjustment Allowances (TRA), individuals who would be
eligible to receive TRA, but have not yet exhausted their unemployment insurance (UI) benefits, and individuals receiving
benefits under Alternative Trade Adjustment Assistance (ATAA) or Reemployment Trade Adjustment Assistance (RTAA),
and who did not elect COBRA during the general election period, may get a second election period. This additional,
second election period is measured 60 days from the first day of the month in which an individual is determined eligible
for the TAA benefits listed above and receives such benefit. For example, if an individual’s general election period runs
out and he or she is determined eligible for TRA (or would be eligible for TRA but have not exhausted UI benefits) or
begin to receive ATAA or RTAA benefits 61 days after separating from employment, at the beginning of the month, he
or she would have approximately 60 more days to elect COBRA. However, if this same individual does not meet the
eligibility criteria until the end of the month, the 60 days are still measured from the first of the month, in effect giving
the individual about 30 days. Additionally, a COBRA election must be made not later than 6 months after the date of the
TAA-related loss of coverage. COBRA coverage chosen during the second election period typically begins on the first day
of that period. More information about the Trade Act is available at doleta.gov/tradeact/.
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AN EMPLOYER’S GUIDE TO GROUP HEALTH CONTINUATION COVERAGE UNDER COBRA
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