What is COBRA?
The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) is a federal law enacted to help prevent gaps in healthcare coverage. COBRA requires employers who provide employees with healthcare coverage (including dental) to permit employees to continue the coverage under certain circumstances when it would otherwise terminate. The employee is responsible for paying the full cost of the continued coverage, in addition to an administrative fee.
Does COBRA affect all companies?
COBRA applies, in general, to companies that employ 20 or more employees on at least 50% of the working days during the preceding calendar year. Please note that under COBRA, employers are required to administer continuation of coverage benefits. To obtain more information about COBRA, including responsibilities as an employer and the duration of the continuation periods, please contact your own legal counsel.
Who qualifies for COBRA benefits?
Any employee or dependent who is enrolled in a Delta Dental PPO, PPO Plus Premier, or DeltaCare USA plan on the day before termination of standard benefits is eligible. Also qualifying are children who are born to or placed for adoption with a qualified COBRA beneficiary during the period of continued coverage, provided such child is enrolled within 30 days of birth or placement for adoption.
What events can trigger COBRA coverage?
There are five Qualifying Events that can initiate continued coverage:
1. Termination of employment (other than termination for gross misconduct), or reduction in work hours;
3. Divorce or legal separation;
4. Loss of dependent status under the plan; or,
5. As to dependents only, an employee's entitlement to Medicare.
How long do COBRA benefits last?
Employees who are qualified beneficiaries may continue coverage for 18 months following the month in which Qualifying Event 1 occurs. For details on qualifying for extended COBRA benefits, please contact your plan administrator. Dependents who are qualified beneficiaries may continue coverage for 36 months following the occurrence of Qualifying Events 2, 3, 4 or 5.
Do COBRA beneficiaries receive the same Delta Dental coverage as active employees?
Yes. The benefits under the continued coverage will be the same as those provided to active employees and their dependents who are still enrolled in the dental plan. If the employer changes the coverage for active employees, the continued coverage will change as well. Dues will be adjusted to reflect the changes made.
What is Cal-COBRA?
The California Continuation Benefits Replacement Act (Cal-COBRA), which became effective on January 1, 1998, requires that every health care service plan contract with a small employer provide a similar opportunity to continue that coverage. The employee, as in the case of COBRA, is responsible for paying the full cost of the continued coverage in addition to an administrative fee.
How is "small employer" defined under Cal-COBRA?
A small employer is defined as one that employed between 2 and 19 employees on at least 50% of the working days during the preceding calendar year. If you are a small employer, either you or Delta Dental can distribute a copy of the disclosure and election form to each employee enrolled in your dental program at the time an enrollee qualifies for Cal-COBRA. If you choose Delta Dental to send the Cal-COBRA form, please provide Allied Administrators (Delta Dental's designated plan administrator) with the employee's and/or dependent's name and address to send the forms.
Should employers notify Delta Dental when an employee qualifies for Cal-COBRA?
Yes. Cal-COBRA requires a small employer to notify Delta Dental's designated administrator, Allied Administrators, of any employee or dependent who has experienced a "qualifying event" within 31 days after such loss of coverage.
How should employers notify Allied Administrators when an employee qualifies for Cal-COBRA?
Employers can notify Allied Administrators via fax (415-439-5861) or email (email@example.com) when an employee qualifies for Cal-COBRA coverage. The employer must provide the employee with a Cal-COBRA Disclosure and Election Form or request that Allied Administrators send one to the employee by providing a name and address to whom it should be sent. The employee is responsible for sending the completed form and premium to Allied Administrators.