The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law that allows employees and their families to keep their health coverage when it would otherwise end. New York State also has a continuation coverage law called "mini-COBRA." Together, the two laws provide up to 36 months of continued coverage. Both laws are referred to as "COBRA."
If you have questions about COBRA coverage, contact your health benefits administrator (HBA) or agency contact. Your General Information Book will also have information regarding COBRA.
Eligibility
If you are a NYSHIP enrollee who is no longer covered through active employment, you have the right to COBRA coverage if your:
- Eligibility for NYSHIP is lost as a result of a reduction in hours of employment or termination of employment.
- NYSHIP coverage is canceled while on leave under the Family and Medical Leave Act (FMLA) and you do not return to work.
- Employer provided you coverage under Preferred List provisions and that coverage has been exhausted. (You may be eligible to continue coverage as a retiree or vestee instead of COBRA.)
Dependents
Dependents who are qualified beneficiaries have an independent right to up to 36 months of COBRA coverage and may elect Individual coverage.
To be considered a qualified beneficiary, a dependent must:
- Have been covered at the time of the enrollee’s initial COBRA-qualifying event or
- Be a newborn or newly adopted child added to coverage within 30 days of birth or placement for adoption.
In no case will any period of continuation coverage last more than 36 months from the initial COBRA-qualifying event.
Eligible dependents may be added to COBRA coverage after it begins, but they do not become qualified beneficiaries. Their coverage ends when the enrollee's COBRA eligibility ends. Newborn or newly adopted children are exceptions.
Spouse/Domestic Partner
The covered spouse or domestic partner of a NYSHIP enrollee has the right to COBRA coverage as a qualified beneficiary if coverage under NYSHIP is lost as a result of:
- Divorce
- Termination of domestic partnership
- Termination or reduction in hours of enrollee's employment
- Death of the enrollee
- The COBRA enrollee's eligibility for Medicare
Spouse, Domestic Partner and Divorce Coverage
Dependent Children
The covered dependent child of a NYSHIP enrollee has the right to COBRA as a qualified beneficiary if coverage under NYSHIP is lost as the result of:
- The child’s loss of eligibility as a dependent under NYSHIP (e.g., due to age)
- Parents' divorce or termination of domestic partnership
- Termination or reduction in hours of enrollee's employment
- Death of the enrollee
- The COBRA enrollee's eligibility for Medicare
A COBRA enrollee’s newborn child or a child placed for adoption with a COBRA enrollee is considered a qualified beneficiary if coverage for the child is requested within 30 days.
Applying
When you or your dependent experience an employment change that affects coverage, you must elect continuation coverage within 60 days from the date of the COBRA-qualifying event or 60 days from the date you are notified of your eligibility for continuation coverage, whichever is later.
Choice of Option
An enrollee or dependent who continues coverage under COBRA will continue to be covered under the same option. COBRA enrollees may change to a different option during Open Enrollment or when moving, in specific circumstances. Dependents of a COBRA enrollee may also change to Individual coverage during Open Enrollment.
Costs Under COBRA
COBRA enrollees pay 100% of the premium for continuation coverage plus up to a 2% administrative fee. EBD will bill you for the COBRA premiums.
COBRA enrollees will have an initial grace period of 45 days to pay the first premium, starting with the date continuation coverage is elected. Since the 45-day grace period applies to all premiums due for periods of coverage prior to the date of the election, several months’ premiums could be outstanding and due.
After the initial 45-day grace period, enrollees will have a 30-day grace period after the premium due date to pay subsequent premiums.
When COBRA Ends
Continuation coverage will end for the following reasons:
- The premium for your continuation coverage is not paid on time
- The continuation period of up to 36 months ends
- The enrollee or enrolled dependent enrolls in Medicare (see your General Information Book for more information)
- You cancel your COBRA coverage
Conversion Rights After COBRA Ends
At the end of your COBRA coverage period, if you were enrolled in The Empire Plan, you may be eligible to convert to a direct-pay conversion contract with the Empire Plan’s Medical/Surgical Program administrator.
If you were enrolled in a NYSHIP HMO, contact that HMO for more information.