Consolidated Omnibus Budget Reconciliation Act of 1985

This article is about the US medical insurance law. For other uses, see Cobra (disambiguation).

The Consolidated Omnibus Budget Reconciliation Act of 1985 (or COBRA) is a law passed by the U.S. Congress on a reconciliation basis and signed by President Reagan that, among other things, mandates an insurance program giving some employees the ability to continue health insurance coverage after leaving employment. COBRA includes amendments to the Employee Retirement Income Security Act of 1974 (ERISA). The law deals with a great variety of subjects, such as tobacco price supports, railroads, private pension plans, emergency room treatment, disability insurance, and the postal service, but it is perhaps best known for Title X, which amends the Internal Revenue Code and the Public Health Service Act to deny income tax deductions to employers (generally those with 20 or more full time equivalent employees) for contributions to a group health plan unless such plan meets certain continuing coverage requirements. The violation for failing to meet those criteria was subsequently changed to an excise tax.

Although this statute became law on April 7, 1986, its official name is the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub.L. 99-272, 100 Stat. 82). Because of the discrepancy between the official name of the Act and the year in which it was enacted,^[1] some government publications refer to the Act as the Consolidated Omnibus Budget Reconciliation Act of 1986. The Act is often referred to simply as "COBRA".

Provisions

As originally enacted, Title X of the Act provided that a qualifying employer will not be permitted to take a tax deduction for its health insurance costs unless its health insurance plan allows employees of the employer and the employee's immediate family members who had been covered by a health care plan to maintain their coverage if a "qualifying event" causes them to lose coverage. However, the legislation was subsequently amended to instead impose an excise tax upon an employer whose health plan fails to satisfy the applicable rules. A qualifying employer is generally an employer with 20 or more full time equivalent employees.^[2]

Among the "qualifying events" listed in the statute are loss of benefits coverage due to (1) the death of the covered employee; (2) an employee loses eligibility for coverage due to involuntary termination or a reduction in hours as a result of resignation, discharge (except for "gross misconduct"^[3][4]), layoff, strike or lockout, medical leave, or slowdown in business operations; (3) divorce or legal separation that terminates the ex-spouse's eligibility for benefits; or (4) a dependent child reaching the age at which he or she is no longer covered. COBRA imposes different notice requirements on participants and beneficiaries, depending on the particular qualifying event that triggers COBRA rights.

COBRA also allows for coverage for up to 18 months in most cases. If the individual is deemed disabled by the Social Security Administration, coverage may continue for up to 29 months. In the case of divorce from the former employee, the former spouse's coverage may continue for up to 36 months. In the case of death of the former employee, the widow's coverage may continue for up to 36 months.

COBRA does not apply, on the other hand, if employees lose their benefits coverage because the employer has terminated the plan altogether or if the employer has gone out of business. In cases where COBRA does not apply, some states have stepped in with state health insurance continuation laws, usually called "mini-COBRA" laws, which help employees continue their health insurance when federal COBRA does not apply.^[5]

COBRA does not, unlike other federal statutes such as the Family and Medical Leave Act (FMLA), require the employer to pay for the cost of providing continuation coverage. Instead it allows employees and their dependents to maintain coverage at their own expense by paying the full cost of the premium the employer and the employee previously paid, plus up to a 2% administrative charge (50% for the latter 11 months under the disability extension).

According to the U.S. Department of Labor:^[6]

...the coverage you are given must be identical to the coverage that is currently available under the plan to similarly situated active employees and their families (generally, this is the same coverage that you had immediately before the qualifying event). You will also be entitled, while receiving continuation coverage, to the same benefits, choices, and services that a similarly situated participant or beneficiary is currently receiving under the plan, such as the right during an open enrollment season to choose among available coverage options. You will also be subject to the same rules and limits that would apply to a similarly situated participant or beneficiary, such as co-payment requirements, deductibles, and coverage limits.

Employees and dependents can also opt for a lesser form of coverage, e.g., to choose continuation coverage under a plan that only covers the employee, but not his or her dependents, or that only provides medical and hospitalization coverage and does not pay for dental work, if those options are available to covered employees.

Employees and dependents lose coverage if they fail to make timely payments of these premiums. Employers are required to inform employees and dependents upon loss of coverage, in writing, by at least fifteen days before the coverage ceases.

Coordination of coverage

An individual covered under COBRA may also be covered by another group health plan or Medicare as long as one of two conditions are met:^[7]

1. The other coverage was in force as of or prior to the coverage under COBRA, or,
2. The other coverage is subject to pre-existing conditions exclusions or limitations.

Subsidy under federal stimulus

Only 10% of Americans eligible for COBRA insurance in 2006 used it, many because they were unable to afford to pay the full premium after their job loss.^[8] While some employers may voluntarily help subsidize or fully cover the cost of COBRA insurance as part of a termination or exit package, it is more common for the ex-employee to cover the entire cost.^[9]

The American Recovery and Reinvestment Act of 2009 as signed by Barack Obama includes a 65% subsidy to employees for COBRA-enabled insurance for up to 9 months ^[10] after an involuntary termination (this has since been expanded to 15 months). An employee is eligible for this subsidy if

• the termination of employment was involuntary,
• the terminated employee has no other group sponsored health insurance option, and
• the terminated employee is otherwise eligible to enroll in COBRA.

If the employee has an adjusted gross income in 2009 over $125,000 if filing as single ($250,000 if filing jointly), then the subsidy will be recaptured in a phased manner from the employee through the tax system.

Termination of employment must have occurred between September 1, 2008 and December 31, 2009 (later expanded to February 28, 2010, expanded again to March 31, 2010, and then expanded again to June 2, 2010). Specific provisions and responsibilities may differ in the state specific mini-COBRA plans for employers with fewer than 20 employees throughout half of the previous calendar year. Those employees who are eligible for the ultimate benefits of this subsidy are referred to as Assistance Eligible Individuals (or AEIs).

Employers subject to Federal COBRA are required to:^[10]

• Notify terminated employees of their potential rights under ARRA by sending a series of notices
• Provide a method for qualified AEIs to enroll
• Pay the full amount of the premiums and seek reimbursement of the 65% subsidy by including it in the Employer's Quarterly Federal Tax Return (Form 941)

This Act was signed into law by President Barack Obama on February 17, 2009.

On December 19, 2009, President Obama signed into law the Department of Defense Appropriations Act, 2010, which made several amendments to the COBRA provisions of the American Recovery and Reinvestment Act of 2009 (ARRA). The Act extends COBRA subsidy eligibility to employees who lost their jobs due to no fault of their own between January 1 and February 28, 2010. The nine-month subsidy period was also expanded to fifteen months.^[11][12]

On March 3, 2010, President Obama signed into law the Temporary Extension Act of 2010.^[13] The Act extends COBRA subsidy eligibility to employees who lost their jobs due to no fault of their own between March 1 and 31, 2010.^[14] In addition, employees who lost group health insurance due to reduced work hours on or after Sept. 1, 2008, followed by involuntary termination between March 2 and March 31, 2010, will now be eligible for the COBRA subsidy.^[15]

The Continuing Extension Act of 2010 extends premium assistance for COBRA benefits through May 31, 2010.^[16]

As of June 2010, an extension of COBRA's premium assistance has not materialized, and attempts by congressional members to include such provisions have been dropped. As of June 1, 2010, all newly unemployed workers must pay full coverage costs as determined by their respective plans.^[17] This is due in part to conservative Democrats in Congress who have expressed concerns about treating some unemployed workers differently than others, such as people priced out of the private insurance market.^[17] A number of Senate Democrats expressed concern about this situation and have introduced legislation to expand COBRA coverage to people who become unemployed through November 2010,^[17] but such legislation did not pass in 2010.

References

1. ^ Discrepancies between the date in the official title of a U.S. budget Act and the date on which the Act was signed into law occur with some frequency. See, for example, the Deficit Reduction Act of 2005, signed into law in February 2006.
2. ^ ERISA cites "(more) than 20 employees on a typical business day during the preceding calendar year".
3. ^ Zickafoose v. UBServices, Inc., 23 F.Supp.2d 652, 655 (S.D.W.Va.1998). "Conduct is gross misconduct if it is so outrageous that it shocks the conscience."
4. ^ When an employee is discharged for gross misconduct, the employer is not required to offer COBRA continuation coverage to the employee, the employee's spouse, or the employee's dependents. See Mlsna v. Unitel Communications, Inc. 41 F.3d 1124 (7th Cir. 1994).
5. ^ [1], Not Eligible For COBRA Health Insurance? You Might Still Be Eligible For Mini-COBRA Health Insurance Continuation," MyHealthCafe.com.
6. ^ "Benefits Under Continuation Coverage" section of Department of Labor - Employee brochure
7. ^ "COBRA Coordination with Other Benefits". Centers for Medicare & Medicaid Services. 6 November 2006. http://www.cms.hhs.gov/COBRAContinuationofCov/12_CoordinationwithOtherBenefits.asp. Retrieved 8 October 2009. 
8. ^ Rovner, Julie (January 28, 2009). "Bill Aims To Subsidize Health Care For Laid-Off". NPR. http://www.npr.org/templates/story/story.php?storyId=99973267. Retrieved 2009-11-08. 
9. ^ "COBRA - Reducing the Costs". HealthHarbor. http://healthharbor.com/cobra-intro/cobra-reducing-costs. Retrieved 2009-11-08. 
10. ^ ^{a b} "DOL Information Related to the American Recovery and Reinvestment Act of 2009". Department of Labor. http://www.dol.gov/recovery/. Retrieved 2009-11-08. 
11. ^ "FAQs On The COBRA Premium Reduction Extension Provisions". Department of Labor. http://www.dol.gov/ebsa/faqs/faq-cobra-premiumreductionEE.html. 
12. ^ Block, Sandra (January 5, 2010). "Another COBRA extension helps with health insurance". USA Today. http://www.usatoday.com/money/perfi/columnist/block/2010-01-04-cobra-extension-health-insurance_N.htm. 
13. ^ "H.R. 4691: Temporary Extension Act of 2010". govtrack.us. Civic Impulse, LLC.. http://www.govtrack.us/congress/bill.xpd?bill=h111-4691. 
14. ^ Pender, Kathleen (March 3, 2010). "Federal unemployment benefits, Cobra subsidy extended for one month". San Francisco Chronicle. http://www.sfgate.com/cgi-bin/blogs/pender/detail?entry_id=58343&tsp=1. 
15. ^ Geisel, Jerry (March 3, 2010). "Obama signs stopgap COBRA subsidy extension". Business Insurance (Crain Communications, Inc.). http://www.businessinsurance.com/article/20100303/NEWS/100309976. 
16. ^ "H.R.4851 - Continuing Extension Act of 2010". May 20, 2010. http://www.opencongress.org/bill/111-h4851/show. 
17. ^ ^{a b c} Alonso-Zaldivar, Ricardo (June 12, 2010). "Obama faces rare defeat on health help for jobless". Associated Press. Yahoo News. http://news.yahoo.com/s/ap/20100612/ap_on_bi_ge/us_health_care_unemployed. Retrieved June 12, 2010. ^{[dead link]}

External links

• US Department of Labor: COBRA FAQs for Employees
• Employee Brochure, Department of Labor (pdf)
• Other Resources, Department of Labor
• COBRA Insurance Information Center (private website)
• Library of Congress THOMAS summary of the Act.
• General information from the Centers for Medicare and Medicaid Services (CMS)
• COBRA insurance information (private website)